opioids, pain, fever, inflammation

The client has been prescribed celecoxib for osteoarthritis. Which statement by the client indicates the need for further client education?

"I will stop taking the medication when I feel better." Osteoarthritis is a chronic condition and it is important the client understand that celeoxib be taken even when the symptoms have subsided

An older adult woman has been experiencing significant joint pain and has informed her primary care provider that she has begun taking aspirin two to three times each day. What aspect of this patient's medical history may contraindicate the use of aspirin?

The patient has a history of peptic ulcer disease Due to the risk of bleeding, aspirin is contraindicated in patients with peptic ulcer disease or bleeding disorders. SSRIs, previous surgery, and type 2 diabetes do not preclude the use of aspirin.

Which client would the nurse identify as being opioid naive?

one who does not routinely take opioids

A female client with acute joint inflammation asks the nurse why she shouldn't use acetaminophen for her condition. What would be the nurse's best response to this client?

"The drug has no effect on inflammation." The drug has antipyretic and analgesic properties, but no anti-inflammatory properties. Acetaminophen does have adverse effects including hepatotoxicity secondary to chronic use or overdose. Long-term therapy or overdosage can lead to hepatotoxicity. The drug does not increase a person's risk for bleeding.

After teaching a local community group about the use of OTC anti-inflammatory agents, the nurse determines that the group needs additional teaching when they state:

"These drugs are relatively safe since they don't have adverse effects." All anti-inflammatory drugs available OTC have adverse effects that can be dangerous if toxic levels of the drug circulate in the body. Since these drugs are available OTC, there is a potential for abuse and overdosing. In addition, these drugs block the signs and symptoms of a present illness. OTC agents, if combined with other drugs, can induce toxicity

The nurse is to administer an opioid antagonist. The nurse knows that the valid reasons for administering this type of medication include what reasons?

- Postoperative acute respiratory depression - Suspected or known acute opioid overdosage - Adverse effects related to opioid administration

When evaluating the plan of care for a client receiving opioid analgesics for pain management, the nurse considers the plan successful when what occurs?

- Therapeutic response is achieved and discomfort is reduced. - An adequate breathing pattern is maintained. - Client maintains adequate nutritional status.

The nurse suspects opioid overdose in a client after surgery. What interventions must the nurse initiate for this client?

- administer naloxone - notify the health care provider - prepare for endotracheal intubation

What effects are exerted by aspirin?

- analgesic - antipyretic - anti-inflammatory

What should a nurse recognize as a property of ibuprofen/Motrin?

- anti-inflammatory - analgesic - antipyretic

Which statements are true of aspirin's effects on platelets?

- aspirin inhibits platelet aggregation. - the effect of aspirin on platelets is irreversible. Aspirin prolongs bleeding time by inhibiting the aggregation of platelets. The effect of aspirin on platelets is irreversible and lasts for the life of the platelet (7 to 10 days).

Nurses need to understand the basic mechanism of how a drug exerts its effects. Which are mechanisms by which NSAIDs elicit their effects?

- inhibition of prostaglandins - inhibition of cyclooxygenase-1

Which should be included when assessing pain?

- location of the pain - intensity of pain - what factors cause the pain to improve or worsen - what medications client usually takes to relieve the pain

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 is capable of restoring respiratory function within 1 to 2 minutes of administration. The shorter the time to restoring respiration the less time the client has to depend on manual or mechanical ventilation and the better the outcome for the client

The nurse administers morphine 15 mg oral solution to a client with cancer pain at 0930. When should the nurse reassess the client for peak effect?

1030 With oral administration, peak activity occurs in about 60 minutes. The duration of action is 5 to 7 hours.

Patients are often given a daily dose of aspirin for prophylaxis of myocardial infarction (MI), transient ischemic attacks (TIA), and cerebrovascular accident (CVA). What is the recommended daily dose for this purpose?

81-325 mg The recommended daily dose for prophylaxis of MI, TIA, and CVA is 81-325 mg. The indication stems from aspirin's ability to decrease formation of blood clots.

A patient arrives at the emergency department brought by their friends. The friends tell the nurse that the patient has taken a whole bottle of aspirin. Blood work for salicylate toxicity is run. What result would the nurse expect?

>20 g Acute salicylate toxicity may occur at doses of 20 to 25 g in adults or 4 g in children.

A client's family asks why the nurse has placed suction equipment in the room immediately after administering a dose of naloxone. Which explanation by the nurse is correct?

Abrupt reversal of opioid-induced respiratory depression may cause vomiting.

A parent has sought care from the nurse practitioner to treat a child's fever. The nurse practitioner is most likely to recommend what nonsalicylate drug?

Acetaminophen Acetaminophen is the most frequently used drug for managing fever and pain in children. Ibuprofen and naproxen are both effective treatments for pain and fever in children but they are not the most commonly used medications. Indomethacin is not indicated for fever control

An adult client has been admitted to the emergency department after deliberately overdosing on approximately 50 grams of acetaminophen. The nurse should prepare for what intervention?

Administration of acetylcysteine as prescribed Acetylcysteine is the antidote to acetaminophen overdose. Naloxone treats opioid overdoses. Given the high dose of acetaminophen, watchful waiting would be inadequate.

A home care nurse is seeing a 66-year-old female who has just been released from the hospital after being treated for pneumonia. The nurse knows that it is important to assess the client's knowledge of which area?

Adverse effects of nonsteroidal anti-inflammatory drugs In addition, adverse drug effects should be reviewed with clients, and clients should be assessed for characteristics (e.g., older age group, renal impairment, overuse of the drugs) that increase the risks of adverse effects.

Mr. Conn, age 65, is taking probenecid for treatment of chronic gouty arthritis. When providing patient and family education, what should a nurse advise the patient to do if he misses a dose and it is almost time for the next dose?

Advise the patient to take only the second dose and ignore the missed dose

While you are speaking with a client diagnosed with gout, she states that she has no symptoms of the disease and asks you to explain why she was prescribed Allopurinol (Zyloprim). Your best response is:

Allopurinol is used to prevent or treat hyperuricemia, which occurs with gout.

The client has difficulty swallowing and requests the nurse to crush all the medications. The nurse notes a client prescribed an extended-release opioid requests that all medications be crushed to facilitate the administration. What information about this form of opioid presents a problem respecting the client's request?

Crushing the medication may precipitate an overdose. Health care providers and clients must be cautioned to avoid crushing or chewing the tablets or opening capsules because immediate release of the drug constitutes an overdose. None of the other answers apply.

Acetaminophen is frequently used as a substitute for aspirin. What effects of aspirin are absent in acetaminophen?

Anti-inflammatory and antiplatelet effects Acetaminophen has antipyretic and analgesic effects equal to those of aspirin.

The client is having surgery this week. What information should the nurse give the client concerning the use of pain medication after surgery?

Ask for pain medication before the pain gets severe.

The nurse is caring for a postoperative client taking an opioid medication for pain. The nurse assesses the client to have bradypnoea and an oxygen saturation value of 90%. Which actions should the nurse perform before administering the ordered opioid antagonist?

Assess the client's other vital signs.

Which of the following is a serious risk involved in the use of NSAIDs?

Cardiovascular thrombosis

The 56-year-old client is diagnosed with osteoarthritis and reports joint pain and stiffness. Which medication would be identified as appropriate for the client to take?

Celecoxib Celecoxib is a OOX-2 inhibitor used to treat pain related to osteoarthritis.

A client who is receiving an opioid develops a slowed breathing pattern due to the drug's effect of somnolence and pain relief. When providing care to this client, which would be most important for the nurse to do?

Coach the client to breathe.

A patient is receiving drugs through a PCA infusion pump. Which of the following information should a nurse offer to the patient for proper administration of the drug through the infusion pump?

Control button activates administration of the drug. The nurse should inform the patient that the control button activates administration of the drug. Pain relief occurs shortly after, and not an hour after, pushing the button. The nurse should educate the patient on the difference between the control button and the button to call the nurse, especially when they are similar in appearance and feel. The machine does not deliver the drug every time the control button is used; the machine regulates the dose of the drug as well as the time interval between doses. If the control button is used too soon after the last dose, the machine will not deliver the drug until the correct time.

Mr. Gregory is being treated for gout with colchicine. He has been taking the medication for over a year now. What is the main adverse reaction of long-term therapy with this medication?

Depressed bone marrow function Long-term colchicine therapy can cause depressed bone marrow function, inducing aplastic anemia, pancytopenia, thrombocytopenia, leukopenia, or agranulocytosis. GI tract distress, nausea, vomiting, diarrhea, abdominal pain, and paralytic ileus are some of the adverse effects that may occur even in short-term colchicine therapy. On the other hand, renal or hepatic failure is not a possible adverse effect of long-term colchicine therapy.

A client with chronic pain has been prescribed a salicylate. The nurse should expect what medication on this client's medication administration record?

Diflunisal Diflunisal is an example of a salicylate. Indomethacin, piroxicam, and celecoxib are examples of NSAIDs.

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

Drowsiness Dizziness, drowsiness, and visual changes are common side effects. If any of these occur, avoid driving, operating complex machinery, or performing delicate tasks. If these effects occur in the hospital, the side rails on the bed may be raised for your own protection. Morphine does not generally cause paresthesia in the lower extremities, an occipital headache, or increased intracranial pressure.

The nurse is caring for a client who has been admitted to the emergency department after a fall. An x-ray indicates that the client has fractured his ankle. Because of a previous stroke, the client does not speak. What other method will the nurse use to assess this client's pain?

Facial expressions Movement of arms and hands Guarding of the leg

A client is to receive a narcotic that will be applied transdermally. The nurse identifies this as which agent?

Fentanyl

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

Fentanyl (Duragesic)

A nurse is caring for a client with low back pain, who has self-administered large doses of ibuprofen for several consecutive days. The nurse should caution the client that overuse of ibuprofen may lead to which?

GI irritation Adverse effects of ibuprofen and other nonsteroidal anti-inflammatory drugs include GI irritation, ulceration, and bleeding

A nurse is caring for a 10-year-old boy who reports chronic headaches. His mother reports that she gives him Tylenol at least three times a day. What will the nurse suspect the health care provider to evaluate in this client?

Hepatic function The nurse would expect the provider to evaluate the client's hepatic function. Severe hepatotoxicity can occur from overuse of acetaminophen.

The client is taking NSAIDs for pain. The nurse explains to the client that NSAIDs act by which actions?

Inhibiting the synthesis of prostaglandins NSAIDs inhibit prostaglandin synthesis by blocking the action of cyclooxygenase. This helps to block pain and inflammation.

An 80-year-old male client presents to the emergency department with a fractured ankle and multiple abrasions and contusions. He is admitted to the hospital with an order for oxycodone for pain. Oxycodone may be prescribed for a geriatric client because the drug has which characteristic?

It has a short half-life and is less likely to accumulate, causing toxicity or overdosage.

Which statement best describes a drug's characteristic of having no ceiling effect?

It is a valuable drug to use because dosage can be increased to relieve pain when pain increases or tolerance develops

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 The nurse should assess respiratory rate and level of consciousness because respiratory depression and sedation are adverse effects of opioid analgesics. Blood glucose levels, electrolytes, and urine output are not priority assessments with opioid ingestion.

When teaching a client about patient-controlled analgesia (PCA), which would the nurse integrate into the teaching plan?

Many postoperative clients require less opioid when PCA is used.

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

A patient is prescribed naloxone for the treatment of postoperative acute respiratory depression after a kidney transplant operation. Which of the following should the nurse identify as the action of naloxone?

Naloxone restores respiratory function The nurse should know that naloxone restores respiratory function within one to two minutes after administration in patients. Naloxone neither stops internal bleeding nor does it restore limb reflexes. Naloxone also does not overcome pain.

The client returns from the post-anesthesia recovery unit. The nurse notes a respiratory rate of 6. Which drug would the nurse anticipate being given immediately?

Narcan

What information should be provided to a client diagnosed with an acetylsalicylic acid allergy?

Nonaspirin form of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided.

Which of the following terms would the nurse expect health care professionals to use to describe drugs used in pain management?

Opioids

A nurse is caring for a patient who is in severe pain and is receiving an opioid analgesic. Which of the following would be the nurse's priority assessments?

Pain intensity, respiratory rate, and level of consciousness

A nurse caring for a patient administered an NSAID for fever reduction records a decrease in urinary output for the patient. Which of the following should the nurse consider as a probable reason for the patient's condition?

Prolonged temperature elevation If temperature elevation is prolonged while on NSAID therapy, hot, dry, flushed skin and a decrease in urinary output may develop; consequently, dehydration can occur

A black client is receiving a high dose of NSAID for pain relief. Which would be most important for the nurse to include in the teaching plan?

Signs and symptoms of gastrointestinal bleeding Blacks have a documented decreased sensitivity to the pain-relieving effects of many anti-inflammatory agents and have an increased risk of developing GI adverse effects to these drugs. Increased dosages may be needed to achieve pain relief, but the increased dosage increases the client's risk for developing adverse GI effects.

An 11-year-old client is having a cavity filled in the left mandibular first molar. The health care provider has prescribed aspirin for pain relief after the procedure. The nurse discovers upon assessment that the child is suffering from a flulike illness. The nurse contacts the health care provider about the prescribed medication for pain. What is the risk if aspirin is administered to this client?

Reye syndrome Aspirin is contraindicated in children with varicella or flulike illness because it is associated with the occurrence of Reye syndrome, a potentially fatal disease characterized by swelling in the brain, increased intracranial pressure, and seizures.

A 15-year-old client is brought to the emergency department by his friends. He reports visual changes, drowsiness, and tinnitus. He is confused and hyperventilating. These symptoms may be attributable to which condition?

Salicylate intoxication Symptoms of salicylate intoxication include nausea, vomiting, fever, fluid and electrolyte deficiencies, tinnitus, decreased hearing, visual changes, drowsiness, confusion, and hyperventilation.

A patient with muscular pain has been prescribed an NSAIDs. What advice should the nurse give the patient to promote an optimal response to NSAID therapy?

Suggest the patient take the NSAID with food and milk. The nurse should suggest that the patient take the drug with food and milk to promote an optimal response to NSAID therapy; this helps minimize the risk of GI effects.

A patient is being seen in the clinic with a new onset of rheumatoid arthritis. The patient has a documented severe allergy to aspirin. Which medication is contraindicated for this patient?

Sulfasalazine (Azulfidine) Sulfasalazine (Azulfidine) is a sulfonamide antibiotic considered a first-line treatment for both adult and juvenile rheumatoid arthritis. It is contraindicated in patients with salicylic hypersensitivity, sulfonamide hypersensitivity, furosemide hypersensitivity, thiazide diuretic hypersensitivity, sulfonylurea hypersensitivity, or carbonic anyhdrase inhibitor hypersensitivity, because it is broken down to a salicylate component and a sulfonamide component.

Keith, 12 years old, is seen in the emergency department for a severe sunburn. He reports pain, which he rates 7/10. What type of pain is he suffering from?

Superficial somatic pain

Which adverse reactions may occur as a result of administering an opioid antagonist?

Sweating, tachycardia, and increased blood pressure

A 65-year-old man who just had a heart attack is placed on aspirin, 81 mg daily. The nurse is explaining the purpose of this medication to the client and his wife. What would be the nurses best explanation?

The aspirin is being prescribed because it reduces your risk of a second heart attack. Because of its antiplatelet and anti-inflammatory effects, low-dose aspirin (81 mg daily) is useful in preventing or reducing the risk of transient ischemic attacks (TIAs), MI, and ischemic cerebral vascular accident (stroke). It is also indicated for clients with a previous MI, chronic or unstable angina, and those undergoing angioplasty or other revascularization procedures.

The nurse would question the health care provider who prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) for which client?

The client diagnosed with peptic ulcers The client diagnosed with peptic ulcer disease is at risk for further GI irritation and bleeding if given NSAIDs, so the nurse would question the health care provider who ordered this drug

Of the following clients, which one will be most likely to develop physical dependence upon the opioid analgesic they are receiving for pain management?

The client living with a chronic noncancer-related illness The client living with a chronic, noncancer-related illness will be the one receiving the highest dose in the most frequent time interval; this client is considered chronically ill. The clients recovering from surgical procedures (cholecystectomy and below-knee amputation) as well as an ankle fracture are receiving opioid analgesics for acute pain, and will be healed before physical dependence develops.

The nurse is caring for a postoperative client with a history of opioid abuse who has been ordered to receive a dose of an opioid antagonist medication. Which issues should the nurse be prepared to address?

The client may begin to demonstrate symptoms of withdrawal.

Clients diagnosed with chronic pain should be given what information regarding opioids' effectiveness?

They should be given on a regular schedule, around the clock. When opioids are required by clients with chronic pain, the main consideration is client comfort, not preventing drug addiction. Effective treatment requires that pain be relieved and prevented from recurring; titration of opioid dosage is usually the best approach. Analgesics should be given on a regular schedule, around the clock. Oral, rectal, and transdermal routes of administration are generally preferred over injections.

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 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. Onset of action is generally rapid and may be seen within one to five minutes. Additional doses may be required to achieve optimal effects.

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 woman has presented to the emergency department after cutting her hand badly on the blade of a food processor. The pain that this woman is currently experiencing is the result of

activation of the woman's delta and C nociceptors

A nurse is caring for a patient who is on morphine therapy. An expected outcome of the morphine therapy would be that the patient has

adequate pain control with minimal adverse effects

A 60-year-old man has told the nurse that he has been treating his joint pain with regular doses of ibuprofen. In order to ascertain the man's risks of experiencing adverse effects, the nurse should assess the patient's

alcohol intake Heavy alcohol use may predispose a patient to hepatic dysfunction.

While providing client teaching relative to inflammatory disorders, the nurse would explain the presence of inflammation as:

an attempt by the body to remove the damaging agent and repair the damaged tissue. Inflammation is the normal body response to tissue damage from any source, and it may occur in any tissue or organ. Local manifestations are redness, heat, edema, and pain. Inflammation may be a component of virtually any illness. Inflammation can be a result of an infection, which may require antibiotic therapy.

When describing the actions of various drugs, a nursing instructor defines the drug as a substance that counteracts the action of something else. The instructor is describing which action?

antagonist An antagonist is defined as a substance that counteracts the action of something else. An agonist is a chemical that binds to a receptor and activates the receptor to produce a biologic response. An analgesic is given to relieve or reduce pain, and an anti-inflammatory is given to reduce the inflammation that can cause pain.

The client reports to the nurse that the client is having ringing in the ears. The nurse questions the client on use of what medication?

aspirin

A client is to receive a narcotic cough syrup. The nurse would expect this preparation to contain:

codeine

A patient with arthritis is on nonsteroidal anti-inflammatory drug (NSAID) therapy. What should be evaluated by the nurse to determine the effectiveness of NSAID therapy?

better mobility

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 reviewing a journal article about a nonsteroidal anti-inflammatory drug (NSAID) that is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke. The nurse is most likely reading about which drug?

celecoxib Celecoxib is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke; however, all NSAIDs may carry a similar risk.

A client with a viral respiratory infection has an intense headache and cough. What drug will best address both of this client's symptoms?

codeine

A nurse will be prepared to administer naloxone (Narcan) to a patient who has had an overdose of morphine. Repeated doses of Narcan will be necessary because Narcan

has a shorter half-life than morphine.

A nurse has admitted a 10-year-old to the short-stay unit. The child reports chronic headaches, and his mother states that she gives the child acetaminophen at least twice a day. What will the nurse evaluate?

hepatic function The nurse should evaluate the patient's hepatic function. Severe hepatotoxicity can occur from over use of acetaminophen.

How do opioid analgesics relieve moderate-to-severe pain?

inhibiting the transmission of pain signals from peripheral tissues to the brain

A client who was recently diagnosed with cancer is now receiving morphine for pain. Since this client has been receiving morphine for only a short time, he is best described by which term?

opiate naive

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

opioids Opioid antagonists may produce withdrawal symptoms in clients physically dependent on opioids. Naloxone has no effect on benzodiazepines, alcohol, or NSAIDs.

After obtaining the history of a client who is prescribed opioid therapy, the nurse determines that the client is opioid naive. The nurse would be especially alert for which effect after the client receives the prescribed opioid?

respiratory depression

The client is 65-years-old and has a diagnosis of cancer. Morphine has been ordered for pain management. Before the administration of morphine, the initial action of the nurse would be to check which?

respiratory rate, depth, and rhythm. The most hazardous adverse effects of morphine relate to excessive CNS depression and include respiratory depression, hypoventilation, apnea, respiratory arrest, circulatory depression, cardiac arrest, shock, and coma. The most frequent adverse effect of morphine is respiratory depression. The nurse's initial action should be to check the client's respiratory rate, depth, and rhythm. Morphine should not be administered to any client with respiratory depression because it may precipitate respiratory arrest. Heart rate, blood pressure, and temperature are important and should be assessed, but doing so would not be the initial action of the nurse.

A patient with gout has been prescribed colchicine, which he is to take orally each day. When providing relevant health education for this patient, the nurse should emphasize the need to avoid

sardines The patient should be encouraged to follow a low-purine diet by avoiding beer, alcohol, organ and game meats, sardines, anchovies, scallops, asparagus, spinach, and peas

A 64-year-old client has been prescribed ibuprofen for osteoarthritis. Which adverse reaction should the client report with the use of ibuprofen?

tarry stool Serious GI events are also listed as a Black Box warning. Gastropathies are commonly associated with ibuprofen. Nausea, vomiting, diarrhea, constipation, flatulence, and abdominal pain may be representative of minor adverse effects in some clients or serious GI toxicity in others. During long-term administration, the most serious effects are peptic ulcer disease or gastritis that leads to GI bleeding or even perforation. These events can occur at any time, with or without warning.

An 80-year-old man has been prescribed oxycodone for severe, noncancer, chronic pain. He tells the nurse that he has difficulty swallowing and asks if he can crush the tablet before swallowing. The nurse will advise the client that:

there is risk of an extremely high dose available all at once if the tablet is crushed.

The nurse teaches a client with rheumatic disease who is being prescribed salicylate therapy to monitor for:

tinnitus

The client has been prescribed one aspirin a day. The nurse understands that is prescribed for which of the following?

to inhibit platelet aggregation Daily low-dose aspirin is prescribed to inhibit platelet aggregation within the heart and brain. Aspirin for osteoarthritis and pain is usually prescribed at a higher dosage

Which conditions would occur due to the administration of an opioid antagonist in a client who is physically dependent on opioids?

withdrawal symptoms Opioid antagonists produce withdrawal symptoms in clients who are physically dependent on opioids. Drowsiness, hypotension, and insomnia do not occur in opioid-dependent clients who are administered opioid antagonists.