Chapter 26: Narcotics, Narcotic Antagonists and Antimigraine Agents

A client's healthcare provider has prescribed meperidine 75 mg PO q4h PRN for the client's chronic pain. What education should the nurse provide to this client regarding this medication?

"Avoid drinking alcohol while taking meperidine."

A 50-year-old woman has been prescribed sumatriptan for the treatment of migraines. What instructions should then the nurse provide to the patient about the safe and effective use of this drug?

"Take this drug as soon as you feel the first signs of a migraine."

The nurse administers butorphanol 1 mg via nasal spray as prescribed but the client reports no significant pain relief. What is the nurse's best action?

Administer another dose in 60 to 90 minutes

A nurse has entered a client's room at the beginning of a shift to quickly assess the client's airway, breathing, circulation, and consciousness. The nurse observes that the client is wincing, stating, " Oh, I am in so much pain right now." What initial question should the nurse ask this client?

"Where exactly are you hurting?"

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

-central nervous (CNS) -respiratory

After administered a dose of ergotamine to a client, what assessments should the nurse prioritize to assure safe care? Select all that apply.

-heart rate -blood pressure

The health care provider has ordered 0.2 mg naloxone to be administered intramuscularly stat. The pharmacy has available naloxone 0.4 mg/mL. How much naloxone will the nurse administer to the client?

0.5 mL

When describing the onset of action of naloxone, the nurse would explain that the drug achieves its effect in which amount of time?

1 to 2 minutes

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

2 mL

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

Fentanyl (Duragesic)

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

a return to normal respiratory rate, rhythm, and depth

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

bowel patterns

A nurse is caring for a client with renal impairment. The client has been prescribed an opioid analgesic. Which nursing intervention would be most appropriate?

consult with the prescriber about lowering the dosage of the drug

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

drowsiness

How will a client's impaired renal function affect the pharmacokinetics of morphine?

duration of action will be prolonged

An elderly client experiencing recurrent tension headaches reports taking an over-the-counter (OTC) combination of acetaminophen, aspirin, and caffeine several times a week. The nurse should recognize that this combination medication may be contraindicated if the client has a history of what medical condition?

gastrointestinal (GI) bleeding

What action should the nurse take when administering meperidine 75 mg IM every 4 hours to a young adult?

give the medication as prescribed

A nurse is assessing a client's pain level. Which would be the most appropriate method?

have the client rate it on a scale of 1 to 10

A 60-year-old client tearfully explains to the nurse how her husband downplays her frequent migraines and tells her that she needs to "just push through a headache." She describes how her migraines have limited her ability to provide childcare for her young grandchildren and explains that she is unable to keep up her garden. The nurse should identify what nursing diagnosis when planning this client's care?

ineffective role performance related to migraine headaches

A client has been administered an opioid. For what effect should the nurse regularly assess?

level of consciousness (LOC)

The nurse is caring for a patient who is receiving an opioid analgesic. What would be a priority assessment by the nurse?

level of consciousness and respiratory rate

Which medications are opioids for which naloxone may be given to counter the effects?

meperidine

A client is undergoing inpatient addiction rehabilitation following many years or addiction to heroin. What medication would be the most useful adjunct to treatment?

methadone

Prior to administering morphine, the nurse checks the client's medication history. The nurse will contact the health care provider and hold the morphine if the nurse notes the client is currently taking which medication?

monoamine oxidase (MAO) inhibitor

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

opioids

A client is prescribed zolmitriptan for migraine headaches. The nurse should instruct the client to administer this drug by which route?

oral

A nurse is caring for a client diagnosed with a migraine. The client received acetaminophen-aspirin-caffeine by mouth. Which method should be used to assess for the therapeutic effects of the medication?

pain scale

An adult client with a history of migraines has been prescribed propranolol. The nurse should identify what goal of therapy when planning care for a client prescribed propranolol?

the client will experience significantly fewer migraines

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

using a pain rating scale

The nursing instructor is talking with the junior nursing class about migraine headaches. What would the instructor tell the students is the method of action of Sumatriptan?

vasoconstrictive on cranial blood vessels

What is a priority nursing assessment of a client prescribed oral sumatriptan?

vital signs

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

within one to five minutes, an effect may be seen

The client returns to the unit following surgery. The client reports being in pain. After checking the medication administration record in the client's chart, the nurse sees that the client has not received the morphine the health care provider has ordered for over an hour. As the order reads q 1-2 hours, the nurse administers the low dose of the morphine. The PACU nurse calls to tell the floor nurse that the nurse forgot to chart the last dose of morphine the client had received just before the client was transferred to the floor. What drug would the floor nurse be sure to have on the unit that is used to reverse the effects of opioids?

Naloxone hydrochloride (Narcan) tartrate

The nurse enters the client's room to see how the client's pain level is because PRN Demerol can be given. The client is sitting up in bed laughing and visiting with family. The client states that the pain is a "10" on a pain scale of 0 to 10. What is the best response by the nurse?

administer the pain medication as ordered

A class of new nursing students is learning how to administer medications to clients. What should the instructor teach the students about giving opiates?

assess the respiratory rate before giving a dose of opiates

The nurse observes that a new client's medication regimen includes sumatriptan. What assessment should the nurse prioritize?

assessing the client for migraine pain

A client suffering from migraine headaches is prescribed sumatriptan. What is the action of the drug?

binding to serotonin to produce vasoconstriction

The client has had a myocardial infarction. The nurse is administering morphine sulfate for the pain. What vital sign would the nurse monitor that directly relates to the use of this narcotic?

respiratory rate

Morphine, an opioid agonist, is administered for both acute and chronic pain. Along with the administered dosage, what determines the patient's response to morphine?

route of administration

Naproxen has been prescribed to a client whose increasingly severe migraines are interfering with work performance and family life. When providing health education to this client, the nurse should instruct the client to consider what intervention?

take the pills with meals to minimize stomach upset