ATI Pharmacology For Nursing (Chapter 36) Application Exercises

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

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

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

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

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."

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

A nurse is planning to administer morphine IV to a client who is postoperative. 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.

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

A nurse is preparing to administer butorphanol to a client who has a history of 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 opioid-dependent clients.

D. Butorphanol can cause abstinence syndrome in opioid-dependent clients. Rationale: A = Butorphanol has less risk for misuse than morphine. B = Butorphanol is less likely to cause respiratory depression than morphine. C = Manifestations of butorphanol toxicity can be reversed with an opioid antagonist if necessary. D = Opioid agonist/antagonist medications (butorphanol) can cause abstinence syndrome in opioid-dependent clients. Manifestations include abdominal pain, fever, and anxiety.

Active Learning Scenario A nurse is providing discharge teaching for a client who is postoperative and has a new prescription for an opioid medication for incisional pain. What should the nurse include in the teaching? Use the ATI Active Learning Template: Medication to complete this item. Therapeutic Uses: Describe for oxycodone. Complications: List three adverse effects for oxycodone. Nursing Interventions: List three.

Therapeutic Uses: Opioid medication is indicated for relief of moderate to severe pain. Complications: -Sedation -Nausea/vomiting -Constipation -Orthostatic hypotension -Urinary retention Nursing Interventions: -Instruct the client not to drive or perform other hazardous activities while using this medication. -Notify the provider for severe nausea or vomiting. -Prevent constipation by increasing intake of liquids and foods with fiver. Consider use of a stool softener or laxatives if necessary. -Move the client slowly from lying or sitting to standing to minimize effects of orthostatic hypotension. -Instruct the client to void every 4 hr. Contact the provider for manifestations of dysuria.