Ch 26: Narcotics, Narcotic Antagonists and Antimigrane Agents

The male client states that he does not have a back injury and that it is his leg that hurts. He feels every one is not listening to him. What is the best response by the nurse?

"Sometimes when there is nerve damage, it shows up as pain in a different part of the body."

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."

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 client's post-surgical pain is severe and persistent. The client states that recent doses of morphine IV have "helped only a little bit." The client has a PRN dose of morphine available, and wants to receive the medication. The client's respiratory rate is 14 breaths per minute. What is the nurse's best action?

Administer the morphine as prescribed and monitor the client's respiratory status closely

The nurse is caring for a patient who is suffering from postoperative pain. The physician orders 2.5 mg of morphine IV q2h. Morphine is supplied in 10 mg/mL vials. How many mL will the nurse administer in each dose?

0.25 mL

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

The client is to take almotriptan 6.25 mg orally for a migraine. Almotriptan is sent to the unit from the pharmacy in 12.5-mg tablets. The nurse will administer how many tablet(s)?

0.5 tab

A client has been prescribed morphine 4 - 6 mg IV q4h PRN. The client reports pain rated at 8/10 and the nurse verifies on the MAR that the client has most often required 6-mg doses. The nurse chooses to administer 6 mg. The drug is available in ampules containing 10mg/mL. How many mL should the nurse withdraw and administer?

0.6 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

The nursing student is learning about agonist-antagonist. For which clients would the use of narcotic agonists-antagonists be appropriate? Select all that apply. A client injured in a motor vehicle accident who rates his pain at 7/10 A client in pain who cannot be given additional narcotics because of a low respiratory rate A client who is in the second stage of labor A pregnant client who has occasional headaches A client who will undergo general anesthesia for orthopedic surgery

>A client injured in a motor vehicle accident who rates his pain at 7/10 >A client who is in the second stage of labor >A client who will undergo general anesthesia for orthopedic surgery

Opioid antagonists such as naloxone should be used cautiously in clients with which conditions? Select all that apply. Women who are pregnant Children in the postoperative period Infants of opioid-dependent mothers Clients who have been administered anesthesia Women who are breastfeeding an infant

>Infants of opioid-dependent mothers >Women who are breastfeeding an infant >Women who are pregnant

The nurse administered a scheduled dose of hydromorphone to a client.30 mintues ago. It is now time to do her follow-up assessment. The nurse should anticipate which findings on her follow-up assessment? Select all that apply. decrease in pain rating slight decrease in respiratory rate Increase in temperature decrease in oxygen saturation disorientation to person, place and time

>decrease in pain rating >slight decrease in respiratory rate

The nurse knows that, of the following clients, who is least likely to be prescribed transdermal fentanyl? A woman 85 years of age A man 25 years of age A man 50 years of age A woman 35 years of age

A woman 85 years of age

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.

The nurse has administered a dose of naloxone and the client's respiratory depression improved within five minutes. When the nurse reassessed the client two hours later, the client demonstrates symptoms of respiratory depression. Which action should the nurse perform next?

Call the provider as another dose of opioid antagonist may be necessary.

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

Fentanyl (Duragesic)

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

Give the medication as prescribed.

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

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

A nurse is caring for a patient with chronic pain who has been prescribed epidural analgesia. The nurse should monitor the patient for which condition after insertion of the epidural catheter and throughout the therapy?

Respiratory depression

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

In order to maximize therapeutic benefit while reducing the risk of adverse effects of sumatriptan, the nurse should encourage the client to implement which intervention?

Take the medication as soon as the earliest symptoms of migraine are sensed.

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.

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?

The route of administration

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.

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.

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

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. What effect should the client be regularly assessed for? You Selected:

level of consciousness (LOC)

Which client would the nurse identify as being opioid naive?

one who does not routinely take opioids

A nurse is caring for a 49-year-old client in the intensive care unit. The client was in a motor vehicle accident and is in severe pain. The client has been given morphine. After 2 days in the unit, the nurse can detect nasal congestion when the client speaks to her. The nurse will monitor for which? renal impairment. myocardial infarction. hypersensitivity to the drug. pneumonia.

pneumonia.

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

withdrawal symptoms

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

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

Assessing the client for migraine pain

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

A client is receiving a narcotic agonist- antagonist parenterally immediately after surgery but will be switched to the oral form when tolerating fluid and food. Which agent would most likely be preferred?

Pentazocine

A nurse should recognize the difference between opioid agonists and the mixed opioid agonists-antagonists. Which are examples of mixed opioid agonist-antagonists? (Select all that apply. Alfentanil (Alfenta) Buprenorphine (Buprenex) Meperidine (Demerol) Nalbuphine (Nubain) Pentazocine (Talwin)

Pentazocine (Talwin) Buprenorphine (Buprenex) Nalbuphine (Nubain)

A client admitted to the emergency department with a migraine headache unrelieved with current prescribed medications. The nurse administers prescribed ketorolac tromethamine 30 mg IV and metoclopramide 10 mg IV, and the client suddenly develops involuntary movement of upper limbs, facial grimacing, sticking out the tongue rhythmically, contractures of the neck and head to one side in a twisting motion, and rapid involuntary spasms of eyelids. Which action would the nurse implement first?

Receive order for diphenhydramine and administer.

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.

What is a priority nursing assessment of a client prescribed oral sumatriptan? Vital signs Urinary output Head to toe assessment Glasgow coma scale

Vital signs

A nurse has entered a client's room at the beginning of a shift to quickly assess the clent'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?"