Ch. 18 Drugs for the Control of Pain

A patient is prescribed aspirin for arthritic pain. Which should the nurse instruct the patient when taking this medication? "There are no major adverse effects of this medication." "Bruising is expected when taking this medication." "It can be safely taken with garlic." "Do not take with alcohol."

"Do not take with alcohol."

A patient who is breastfeeding is prescribed morphine for pain and asks if the medication will affect the baby. Which response should the nurse provide? "We don't know how morphine will affect your baby, but you need the medicine." "I will talk with the healthcare provider about a different type of medication." "Morphine will have no effect on your baby if you are breastfeeding." "You will need to wean your baby before taking this medication."

"I will talk with the healthcare provider about a different type of medication." Rationale: Morphine is a Pregnancy category B or category D in long-term use or with high doses. The best response is to discuss the prescription with the healthcare provider because the medication has a duration of 7 hours. The baby does not need to be weaned. Morphine can effect the baby if breastfeeding. Morphine can cause adverse effects in an infant who is being breastfed.

The nurse is asked to explain the cause of pain. Which response should the nurse make? "Pain is caused by some imbalance in the body." "There is no real explanation for the development of pain." "Pain occurs when free nerve endings are stimulated." "Pain is an overused term that may be used to describe any feeling that is not normal."

"Pain occurs when free nerve endings are stimulated."

A patient is prescribed a new medication for migraine headaches. Which statement should the nurse include when teaching about this medication? "Take the medication once the pain becomes moderate to severe." "Make sure to promptly report any severe itching." "You should take the medication at the first sign of a migraine headache." "You'll need to return to the clinic for a pregnancy test before you can use this medication again."

"You should take the medication at the first sign of a migraine headache." Rationale: The patient should be instructed to take the medication as soon as the first symptoms begin to minimize the risk for severe pain. Waiting until the pain becomes severe makes it more likely that the medication will not work as well. Some migraine headache medications should be avoided in pregnancy, although regular pregnancy testing is not required. Itching is not an expected adverse effect.

A patient is given oral sumatriptan (Imitrex). After which amount of time should the nurse assess the effectiveness of this medication? 120 minutes 15 minutes 45 minutes 30 minutes

120 minutes Rationale: An oral dose of sumatriptan peaks in 2 hours or 120 minutes. Effectiveness should be assessed at this time. Assessing any sooner will not help determine effectiveness.

A patient receives a subcutaneous dose of naloxone (Narcan) for a respiratory rate of 6 breaths/min caused by an opioid analgesic. At which time should the nurse assess the effectiveness of this medication? 30 to 60 minutes 1 to 2 minutes 15 to 30 minutes 5 to 15 minutes

5-15min Rationale: Naloxone (Narcan) has an onset of action of 2-5 minutes if given subcutaneously and peaks within 5 to 15 minutes. The effectiveness will not be observed at 1 to 2 minutes. The effectiveness of the medication may begin to wear off after 15 minutes. The effectiveness should be assessed before 30 minutes or 1 hour.

The nurse notes that several patients are receiving sumatriptan (Imitrex) for migraine headaches. Which patient should be monitored for adverse cardiovascular effects? A 49-year-old male patient who is a nonsmoker A 25-year-old female patient with chronic migraine headaches A 67-year-old female patient with migraine headaches and hypertension A 37-year-old male patient with a history of gastritis

A 67-year-old female patient with migraine headaches and hypertension

The nurse is monitoring patients receiving opioid therapy for pain relief. For which patient should the nurse administer an opioid antagonist? A patient with a blood pressure of 126/84 mmHg A patient with a respiratory rate of 7 breaths/min A patient with an oxygen saturation of 96% A patient with a pulse of 68 beats/min

A patient with a respiratory rate of 7 breaths/min

The nurse is reviewing information received during hand-off communication. For which patient should the nurse anticipate a prescription for an opioid analgesic? A patient one week post-operative abdominal surgery A patient with a history of substance use A patient with chronic back pain A patient with advanced cancer who needs around-the-clock pain relief

A patient with advanced cancer who needs around-the-clock pain relief Rationale: Opioids are the first-line drugs for severe to extreme pain that cannot be controlled with other classes of analgesics. The patient with advanced cancer requiring around-the-clock pain relief is the most appropriate for an opioid analgesic. Chronic back pain and one week post-operative surgical pain can be treated with a less potent analgesic. The patient with a history of substance use should not be given an opioid analgesic.

A patient reports severe itching after receiving several doses of morphine (Astramorph). Which action should the nurse take? Administer prescribed antihistamine. Document the finding. Withhold the next dose of pain medication until the itching has passed. Discontinue the use of the medication completely.

Administer prescribed antihistamine. Rationale: Itching is a common adverse effect of opioid analgesics. An antihistamine should be provided to relieve the itching. Documenting the adverse effect should be done but it is not a priority. It is not necessary to discontinue or withhold the medication.

A patient who is laughing with visitors requests pain medication for severe postsurgical pain. Which action should the nurse take? Administer 325 mg of acetaminophen. Refuse to administer the pain medication. Give the patient a back massage. Administer the pain medication as prescribed.

Administer the pain medication as prescribed.

Several patients are receiving an opioid for pain management. Which patient should the nurse closely monitor during ambulation? An 87-year-old patient recovering from surgery A 42-year-old patient who had surgery 6 days ago A 10-year-old patient with a broken arm A 26-year-old patient scheduled for surgery in the morning

An 87-year-old patient recovering from surgery Rationale: Older adults are at significantly higher risk for falls or injury when taking opioids due to the risk of dizziness and hypotension. The 87-year-old patient is most at risk for injury. The other patients are younger and are at less risk of falls after administration of opioid medication.

A patient requests medication for pain. Which action should the nurse take before administering this medication? Assess for intensity, character, and location of the pain. Implement nonpharmacologic pain relief measures. Ask visitors to leave so the patient can rest. Check the medical record for a history of addiction.

Assess for intensity, character, and location of the pain.

A patient who is postmenopausal received a dose of sumatriptan (Imitrex) Which assessment should the nurse complete Liver function Musculoskeletal pain Cardiovascular status Kidney function

Cardiovascular status Rationale: Patients who are postmenopausal, men over age 40, smokers, and people with known coronary artery disease risk factors are at a greater risk for cardiovascular adverse effects from triptans and ergot alkaloids. Sumatriptan is contraindicated in patients with acute kidney injury (AKI) or hepatic impairment. Musculoskeletal pain and liver damage are not associated with this drug.

A patient is prescribed an opioid analgesic for pain. Which instruction should the nurse provide to prevent orthostatic hypotension? Change positions slowly, especially when moving to an upright position. Avoid cutting, chewing, or breaking tablets open. Avoid taking calcium or iron supplements. Remain in a reclining position and avoid being upright.

Change positions slowly, especially when moving to an upright position.

The nurse is reviewing documentation for a patient with severe low back pain. Which statement should the nurse question? "Has had acute low back pain for the last 2 weeks." "Experiencing chronic pain that is interfering with the ability to perform activities of daily living." "Reports acute pain that is improving after routine use of over-the-counter analgesics." "Experiencing chronic pain for the last few days."

Experiencing chronic pain for the last few days. Rationale: Chronic pain is longer lasting pain that may persist for weeks, months, or years. Pain lasting longer than six months can interfere with activities of daily living and can contribute to feelings of helplessness or hopelessness. Acute pain is an intense pain occurring over a brief time, usually from time of injury until tissue repair.

A patient experiences respiratory depression after opioid administration. Which type of receptor should the nurse recognize is responsible for this effect? Mu Delta Alpha Beta

Mu Rationale: Medications that cause respiratory depression activate the mu receptor. The beta, delta, and alpha receptors are not responsible for respiratory depression in patients taking an opioid.

A patient experiences burning and shooting pain in the feet. Which type of pain should the nurse document for this patient? Somatic Neuropathic Nociceptor Visceral

Neuropathic Rationale: Neuropathic pain is caused by an injury or irritation to the nerve tissue and is often described as a burning or shooting pain. -Nociceptor refers to activation of receptor nerve endings that receive and transmit pain signals to the central nervous system (CNS). -Somatic pain produces sharp, localized sensations in the body. -Visceral pain produces generalized dull and internal throbbing or aching pain.

A patient experiencing pain is prescribed a nonsteroidal anti-inflammatory drug (NSAID). In which way should the nurse expect this patient's pain to be managed? Release of substance P Nocioceptor level Central nervous system Inhibition of endorphins

Nocioceptor level (sensory receptor for painful stimuli) Rationale: NSAIDs act at the nociceptor level. Opioids act within the CNS. The neurotransmitter substance P is thought to be responsible for continuing the pain message to the brain. The activity of substance P may be affected by other neurotransmitters including endorphins.

A patient with advanced cancer is experiencing intractable pain. Which medication should the nurse anticipate being prescribed? Opioid with mixed agonist-antagonist effect Nonsteroidal anti-inflammatory drug (NSAID) Opioid antagonist Opioid analgesic

Opioid analgesic Rationale: Opioids are the first-line drugs for severe to extreme pain that cannot be controlled with other classes of analgesics. The patient with advanced cancer and intractable pain is the most appropriate for an opioid analgesic. An opioid with mixed agonist-antagonistic effect and an NSAID would not be appropriate for pain relief for this patient. An opioid antagonist would be used in the event of an opioid overdose.

The nurse is reviewing medications prescribed for a patient. For which medication should the nurse provide teaching about orthostatic hypotension? Opioid analgesic Nonsteroidal anti-inflammatory drug (NSAID) Opioid antagonist Caffeine

Opioid analgesic Rationale: Opioids may cause hypotension as an adverse effect and increase the risk of falls or injuries. Orthostatic hypotension is not identified as an adverse effect of opioid antagonists, caffeine, or NSAIDs.

A patient recovering from surgery reports an allergy to acetaminophen. Which pain medication combination should the nurse expect to administer? Percocet Vicodin Endocet Percodan

Percodan Rationale: Percodan is a combination drug containing oxycodone and aspirin. Endocet, Percocet, and Vicodin all contain acetaminophen and should not be administered to a patient with an allergy to acetaminophen.

A patient receiving around-the-clock opioids for pain relief has a respiratory rate of 7 breaths/min. Which action should the nurse take? Repeat the vital sign measurement in 15 minutes. Administer the next dose of pain medication as prescribed. Document the finding in the patient's chart. Prepare to administer naloxone (Narcan).

Prepare to administer naloxone (Narcan). Rationale: A respiratory rate of 7 breaths/min is dangerously low and indicates respiratory depression, a serious adverse effect of opioids. An opioid antagonist is indicated. The next pain medication dose should not be provided because it could cause further respiratory depression. Waiting to reassess the vital signs could cause the patient's condition to deteriorate. The nurse needs to do more than document the vital signs.

A patient with a migraine headache is prescribed sumatriptan (Imitrex). For which reason should the nurse question this medication? Family history of mental illness Family history of lung cancer Treatment for osteoarthritis Recent myocardial infarction

Recent myocardial infarction

A patient is experiencing neuropathic pain. Which description of pain should the nurse expect the patient to report? Shooting or burning Sharp and localized Dull or aching Widespread

Shooting or burning Rationale: Neuropathic pain is caused by an injury to a nerve or nervous tissue. It is often described as burning, shooting, numbing, or stabbing pain. It is not widespread. Somatic pain produces sharp and localized sensations, whereas visceral pain is described as dull, throbbing, or aching pain.

A patient experiences moderate migraines once or twice a month with occasional nausea and vomiting. Which medication should the nurse anticipate being prescribed? Caffeine Sumatriptan (Imitrex) Ibuprofen (Motrin) Dihydroergotamine (DHE 45)

Sumatriptan (Imitrex) Rationale: Pharmacotherapy of a mild migraine begins with acetaminophen or NSAIDs. If an over-the-counter medication or an NSAID such as ibuprofen is unable to stop the migraine, the preferred drug is a triptan. Although oral forms of the triptans are most convenient, patients who experience nausea and vomiting during the migraine may require an alternative dosage form. Caffeine is not strong enough for this level of migraine. Dihydroergotamine has nausea and vomiting as an adverse effect.

The nurse notes tight neck muscles in a patient with a moderate headache. Which health problem should the nurse suspect? Slipped cervical disk Migraine headache Anxiety Tension headache

Tension headache

A patient is prescribed morphine sulfate (Astramorph PF) for postoperative pain. For which situation should the nurse consider withholding the medication? The patient's vital signs are pulse 92, respirations 26, and blood pressure 146/90 mm Hg. The patient's level of consciousness changes from alert to disoriented. The patient reports acute pain from a fractured right tibia prior to surgery. The patient is restless and anxious and has cool, clammy skin.

The patient's level of consciousness changes from alert to disoriented.

A patient with severe pain is prescribed morphine. Which supplement should the nurse instruct the patient to avoid taking with this medication? Vitamin D Valerian Melatonin Garlic

Valerian Rationale: Valerian may potentiate the effect of morphine and should not be taken. Melatonin, vitamin D, and garlic are not identified as altering the effects of morphine.