Pharmacology Chapter 10

18. A patient with bone pain caused by metastatic cancer will be receiving transdermal fentanyl patches. The patient asks the nurse what benefits these patches have. The nurse's best response includes which of these features? a More constant drug levels for analgesia b Less constipation and minimal dry mouth c Less drowsiness than with oral opioids d Lower dependency potential and no major adverse effects

a More constant drug levels for analgesia

15. When assessing a patient for adverse effects related to morphine sulfate, which effects would the nurse expect to find? (Select all that apply.) a. Decreased peristalsis b. Diarrhea c. Delayed gastric emptying d. Urinary retention

a. Decreased peristalsis c. Delayed gastric emptying d. Urinary retention

6. When assessing for the most serious adverse reaction to a narcotic analgesic, what does the nurse monitor for in the patient? a. Respiratory rate b. Heart rate c. Blood pressure d. Mental status

a. Respiratory rate

7. Which medication is used to treat a patient suffering from severe adverse effects of a narcotic analgesic? a. naloxone (Narcan) b. acetylcysteine (Mucomyst) c. methylprednisolone (Solu-Medrol) d. flumazenil (Romazicon)

a. naloxone (Narcan)

19. Intravenous morphine is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.) a Diarrhea b Constipation c Pruritus d Urinary frequency e Nausea

b Constipation c Pruritus e Nausea

22. An opioid analgesic is prescribed for a patient. The nurse checks the patient's medical history knowing this medication is contraindicated in which disorder? a Renal insufficiency b Severe asthma c Liver disease d Diabetes mellitus

b Severe asthma

8. A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse why she is receiving codeine when she does not have any pain. The nurse's response is based on knowledge that codeine also has what effect? a. Stimulation of the immune system b. Cough suppressant c. Expectorant d. Bronchodilation

b. Cough suppressant

10. The nurse is preparing to administer an injection of morphine to a patient. Assessment notes a respiratory rate of 10 breaths/min. Which action will the nurse perform? a. Administer a smaller dose and record the findings. b. Notify the physician and delay drug administration. c. Administer the prescribed dose and notify the physician. d. Hold the drug, record the assessment, and recheck in 1 hour.

b. Notify the physician and delay drug administration.

4. While admitting a patient for treatment of an acetaminophen overdose, the nurse prepares to administer which medication to prevent toxicity? a. naloxone (Narcan) b. acetylcysteine (Mucomyst) c. methylprednisolone (Solu-Medrol) d. vitamin K

b. acetylcysteine (Mucomyst)

5. Massage therapy is ordered as adjunct treatment for a patient with musculoskeletal pain. The patient asks the nurse how "rubbing my muscles" will help the pain go away. The nurse responds based on the knowledge that a. massaging muscles decreases the inflammatory response that initiates the painful stimuli. b. massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain. c. massaging muscles activates small sensory nerve fibers that send signals to the spinal cord to open the gate and allow endorphins to reach the muscles and relieve the pain. d. massaging muscles helps relax the contracted fibers and decrease painful stimuli.

b. massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain.

2. A patient is admitted to the psychiatric unit for treatment of narcotic addiction. The nurse would anticipate administration of which medication? a. morphine b. methadone c. meperidine d. naloxone

b. methadone

20. Several patients have standard orders for acetaminophen as needed for pain. When the nurse reviews their histories and assessments, the nurse discovers that one of the patients has a contraindication to acetaminophen therapy. Which patient should receive an alternate medication? a A patient with a fever of 103.4° F (39.7° C) b A patient admitted with deep vein thrombosis c A patient admitted with severe hepatitis d A patient who had abdominal surgery 1 week earlier

c A patient admitted with severe hepatitis

17. A patient is receiving an opioid via a PCA pump as part of his postoperative pain management program. During rounds, the nurse finds him unresponsive, with respirations of 8 breaths/min and blood pressure of 102/58 mm Hg. After stopping the opioid infusion, what should the nurse do next? a Notify the charge nurse b Draw arterial blood gases c Administer an opiate antagonist per standing orders d Perform a thorough assessment, including mental status examination

c Administer an opiate antagonist per standing orders

3. A patient has been admitted after overdosing on acetaminophen (Tylenol), with a total ingested dose of 14 g over a period of 1 hour. The nurse plans to monitor this patient for development of which of the following signs and symptoms related to the overdose? a. Renal failure b. Kidney stones c. Acute hepatic necrosis d. Metabolic alkalosis

c. Acute hepatic necrosis

12. The nurse teaches a patient prescribed the fentanyl (Duragesic) transdermal delivery system to change the patch at what interval? a. When pain recurs b. Every 24 hours c. Every 72 hours d. Once a week

c. Every 72 hours

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

c. Impaired gas exchange related to respiratory depression

13. The nurse plans pharmacologic therapy for a patient with pain based on the knowledge that a. narcotic analgesics should not be used for more than 24 hours secondary to the risk of addiction. b. analgesics should be administered as needed (prn) to minimize side effects. c. pain relief is best obtained by administering analgesics around the clock. d. patients should request analgesics when the pain level reaches a "6" on a scale of 1 to 10.

c. pain relief is best obtained by administering analgesics around the clock.

9. In monitoring a patient for adverse effects related to morphine sulfate, the nurse assesses for stimulation of a. autonomic control over circulation. b. the cough reflex center. c. the chemoreceptor trigger zone. d. respiratory rate.

c. the chemoreceptor trigger zone.

16. For best results when treating severe pain associated with pathologic spinal fractures related to metastatic bone cancer, the nurse should remember that the best type of dosage schedule is to administer the pain medication a as needed. b around the clock. c on schedule during waking hours only. d around the clock, with additional doses as needed for breakthrough pain.

d around the clock, with additional doses as needed for breakthrough pain.

11. A patient receiving narcotic analgesics for chronic pain can minimize the gastrointestinal (GI) side effects by a. taking Lomotil with each dose. b. eating foods high in lactobacilli. c. taking the medication on an empty stomach. d. increasing fluid and fiber in the diet.

d. increasing fluid and fiber in the diet.

1. A patient needs to switch analgesic drugs secondary to an adverse reaction to the present regimen. The patient is concerned that he will not receive an effective dose of a new drug to control pain. The nurse responds based on knowledge that potencies of analgesics are determined using an equianalgesic table comparing doses of these drugs with what prototype? a. meperidine b. fentanyl c. codeine d. morphine

d. morphine

21. The nurse is administering an intravenous dose of morphine sulfate to a 48-year-old postoperative patient. The dose ordered is 3 mg every 3 hours as needed for pain. The medication is supplied in vials of 4 mg/mL. How much will be drawn into the syringe for this dose?

0.75mL