Chapter 26: Narcotics, Narcotic Antagonists and Antimigraine Agents

A client is prescribed sumatriptan. Which statement should be included in the teaching plan regarding how the medication works?

"It produces vascular constriction of cranial blood vessels." Explanation: Sumatriptan binds to the serotonin receptors 5-HT1D, producing vascular constriction of the cranial blood vessels and relieving the pain of a migraine headache. It also relieves the nausea, vomiting, photophobia, and phonophobia that accompany the migraine headache. Sumatriptan does not cause bronchiole constriction or impair the reuptake of norepinephrine. It does not relax smooth muscles of the cardiovascular system.

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 Explanation: A respiratory rate of 14 breaths per minute is lower than expected, but is not low enough to warrant withholding a client's medication. The nurse should give the medication and monitor the client closely. There is no clear need to contact the provider.

The nurse is caring for a postoperative client taking an opioid medication for pain. The nurse assesses the client to have bradypnea 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. Explanation: Blood pressure, pulse, and respirations are important assessments to make prior to administering an opioid antagonist. It is unnecessary to call for a respiratory therapy consult because the cause of the respiratory depression is known. While assessing and managing pain are important postoperative interventions, the respiratory depression-management interventions are the most important ones to be addressed.

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

Assessing the client for migraine pain Explanation: Sumatriptan is indicated for the treatment of acute migraine and cluster headaches. As such, the nurse should assess the client for indications of this health problem, more so than respiratory status or blood pressure. Narcotic withdrawal syndrome is unrelated.

What is a priority nursing assessment of a client prescribed oral sumatriptan?

Blood pressure Explanation: After administration of sumatriptan, the nurse should assess for adverse effects. These include increased blood pressure as well as chest pain, shock, dizziness and vertigo. Urine output and head to toe assessment are not warranted. The Glasgow comas scale is used to determine best neurological function and not migraine pain.

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. Explanation: The effects of some opioids may last longer than the effects of naloxone. A repeat dose of naloxone may be ordered if results obtained from the initial dose are unsatisfactory. Therefore, calling for an order would be an appropriate response. Taking no action in light of respiratory depression, or merely continuing to monitor the client, could lead to deterioration in the client's condition. No medication should be administered without a provider order.

The nurse educates the client who has just been given a prescription for ergotamine to call the health care provider if the client develops which symptoms? (Select all that apply.)

Chest pain Weakness Palpitations Explanation: Ergotamine may cause both cardiovascular and musculoskeletal adverse effects. The cardiovascular adverse effects of ergotamine include absence of pulse, bradycardia, cardiac valvular fibrosis, cyanosis, edema, heart rhythm changes, gangrene, hypertension, ischemia, precordial distress, chest pain, tachycardia, and vasospasm. Musculoskeletal adverse effects include muscle pain, numbness, paresthesia, and weakness.

What are adverse effects a nurse should assess for when administering ergotamine to a client? Select all that apply.

Decreased pulse and blood pressure Urinary output Explanation: Following administration of ergotamine, the nurse assesses for cardiovascular adverse effects. Measurement of pulse and blood pressure is essential. The nurse also assesses for vertigo, muscle pain, numbness, paresthesia, and weakness, as well as for signs and symptoms of a hypersensitivity reaction to ergotamine. The nurse also assesses the patient's urinary elimination due to the adverse effect of retroperitoneal fibrosis. Pain, headache, diarrhea, GI upset and increased muscle strength are not associated with ergotamine.

The nurse receives a phone call from a male client who has become constipated while taking the opioid analgesic prescribed for his pain. The nurse instructs the client to do what to help relieve this problem? (Select all that apply.)

Drink 2 to 3 quarts of water per day Take a daily stool softener Try to establish a regular bowel routine Explanation: Constipation is a common problem that occurs with the use of opioids. The client should be encouraged to eat a high-fiber diet, drink 2 to 3 quarts of water, take daily stool softener and laxative (if OK'd by a health care provider), and establish a bowel routine

A client is receiving drug therapy for prevention of an acute migraine attack. Which agent would be the most helpful?

Ergotamine Explanation: Ergotamine, an ergot derivative, would be most appropriate for the prevention and treatment of an acute migraine attack. Triptans such as sumatriptan and eletriptan are used for treatment of an acute migraine but not prevention. Naloxone is used to reverse the effects of opioids.

The nurse is caring for a client taking pentazocine/naloxone. What would be an appropriate nursing diagnosis for this client's care plan?

Impaired gas exchange related to respiratory depression Explanation: The correct nursing diagnosis includes impaired gas exchange related to respiratory depression. Appropriate nursing diagnosis does not include diarrhea or disturbed perception related to CVS effects.

A 12-year-old cancer client is receiving morphine 5-10 mg PO q6 hours. The 12-year-old reports being in pain. The nurse checks the medication record and finds that it has been 5 1/2 hours since the client last received pain medicine. What would the nurse do?

Give the client 5 mg of morphine PO. Explanation: With oral administration, peak activity occurs in about 60 minutes. The duration of action is 5 to 7 hours. PO dosage with immediate-release morphine, 5-30 mg q4h PRN.

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

Give the medication as prescribed. Explanation: The client should be administered the full dose of medication, which is within dosing recommendations. A client with adequate hepatic and renal function should not receive a lower dose of meperidine without specific instruction from the prescribing care provider. There is no apparent reason to change the route of administration, and such action cannot be implemented without the instruction of the prescribing care provider.

A client diagnosed with a migraine has been prescribed naproxen. What is the nurse's priority when the client reports being allergic to aspirin?

Hold the medication. Explanation: The nurse's priority is to hold the medication. Contraindications to naproxen or naproxen sodium include a known allergy to aspirin or other nonsteroidal anti-inflammatory drugs. The nurse should not discuss this with the client but with the prescriber. The nurse should not give the medication or call the pharmacy for clarification.

A client who has been prescribed sumatriptan as abortive therapy for migraines reports, "I took that pill about an hour-and-a-half ago, but I feel like a headache is returning. Can I take another pill?" How should the nurse respond?

"Wait at least half-an-hour before you take another pill." Explanation: Clients can take a second dose of oral sumatriptan when symptoms return but no sooner than 2 hours after the first tablet. There's no evidence that the client needs to go to the emergency department.

A nurse has entered a client's room at the beginning of a shift to quickly assess the client'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?" Explanation: To begin the pain assessment, first determine the location of the pain. Location gives possible clues to the source of the pain and can help identify whether the pain is acute or of a more chronic nature. Questions about preferred treatments and the timing of the pain are appropriate and important, but it is normally necessary to first ascertain the location of the client's 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 Explanation: 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.

Naloxone 2 mg IM has been ordered for a post surgical client. The pharmacy has sent to the floor naloxone 1 mg/mL. How many milliliters of naloxone will the client receive? Record the answer as a whole number.

2 Explanation: The nurse is to administer 2 mg of naloxone. The pharmacy has supplied 1 mg/1 mL. Therefore, in order to administer 2 mg, the nurse must administer 2 mL.

A nurse should recognize the situations when naloxone (Narcan) should be used cautiously. What represents one of those situations? (Select all that apply.)

A client who is pregnant A client with cardiovascular disease A client with an opioid dependency Explanation: Opioid antagonists like naloxone (Narcan) should be used cautiously in those who are pregnant or lactating, in infants of opioid-dependent mothers, and in patients with an opioid dependency or cardiovascular disease.

The nurse knows that, of the following clients, who is least likely to be prescribed transdermal fentanyl?

A woman 85 years of age Explanation: The transdermal route of medication administration is dependent upon the amount of subcutaneous tissue present for medication distribution. Subcutaneous tissue is reduced as a result of the aging process. Therefore, the client 85 years of age would be least likely to be prescribed a transdermal medication. The clients 25, 35 and 50 years of age would have adequate subcutaneous tissue for medication distribution.

The anatomy and physiology instructor is talking about pain sensations. What responds to stimulation by generating nerve impulses that produce pain sensations?

A-delta sensory nerves Explanation: Two small-diameter sensory nerves, A-delta and C fibers, respond to stimulation by generating nerve impulses that produce pain sensations. Large-diameter sensory nerves, A fibers, transmit sensations associated with touch and temperature. Mu-receptors are primarily pain-blocking receptors and sigma-receptors cause papillary dilation and may be responsible for the hallucinations, dysphoria, and psychoses that can occur with narcotic use.

The nurse administers butorphanol 1 mg via nasal spray as prescribed but the client reports no significant pain relief. What is the nurse's best action?

Administer another dose in 60 to 90 minutes Explanation: After a first dose of butorphanol via nasal spray, another dose may be given in 60 to 90 minutes and then in 3 to 4 hours as needed and ordered.

The nurse suspects opioid overdose in a client after surgery. What interventions must the nurse initiate for this client? (Select all that apply.)

Administer naloxone Notify the health care provider Prepare for endotracheal intubation Explanation: The nurse will notify the provider, administer naloxone, and prepare for endotracheal intubation. If the client has an IV, the nurse would increase the rate. It is possible the nurse would insert a Foley catheter, but it is not a priority nursing intervention at this time. The priority interventions revolve around the client's respiratory status.

When evaluating the plan of care for a client receiving opioid analgesics for pain management, the nurse considers the plan successful when what occurs? (Select all that apply.)

Therapeutic response is achieved and discomfort is reduced. An adequate breathing pattern is maintained. Client maintains adequate nutritional status. Explanation: The plan of care is considered effective when therapeutic response is achieved and discomfort is reduced; an adequate breathing pattern is maintained; the number of bowel movements is maintained; and adequate nutritional status is maintained. Urinary output should mirror increased fluid intake (increased fluid in, increased fluid out).

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. Explanation: Onset of action is generally rapid and may be seen within one to five minutes. Additional doses may be required to achieve optimal effects. The other answers are incorrect because they are referring to a time later than onset of action, or refer to a conditional onset of action that is untrue.

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. Explanation: Morphine, like most opioid analgesics, creates a risk for constipation. The drug is unlikely to influence the client's temperature, skin integrity, or urine specific gravity.

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

codeine. Explanation: Typically, codeine or hydrocodone are used to relieve coughing.

A client has been prescribed naproxen for the treatment of migraines. The nurse who will administer the medication is aware that the black box warning that accompanies this drug will consequently prioritize what assessment?

heart rate and rhythm Explanation: The FDA has issued a black box warning stating that naproxen sodium may put clients at increased risk for cardiovascular events and GI bleeding. Renal failure, liver failure, and reduced deep tendon reflexes are not the focus of this black box warning.

A nurse should not administer an opioid antagonist to a client with which finding?

hypersensitivity to naloxone Explanation: The use of opioid antagonists is contraindicated in those with a hypersensitivity to the opioid antagonists; therefore, a client with a hypersensitivity to naloxone should not be given the drug. Naloxone can be given to uncontrolled type 2 diabetics. Having a history of opioid or alcohol abuse does not have any effect on the use of naloxone.

Which medications are opioids for which naloxone may be given to counter the effects?

Meperidine Explanation: Meperidine is an opioid medication for which naloxone is an opioid antagonist, and for which naloxone counters the effects. Acetaminophen is not an opioid medication and naloxone would have no effect on a client receiving this medication. Ibuprofen and naproxen are nonsteroidal anti-inflammatory drugs, and naloxone would have no effect on a client receiving these medications.

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 Explanation: Methadone is used for detoxification and temporary maintenance treatment of narcotic addiction. Oxycodone is used for the relief of moderate to severe pain in adults. Oxymorphone is used for the relief of moderate to severe pain in adults, preoperative medication, and obstetrical analgesia. Tramadol is used for the relief of moderate to moderately severe pain, and its use should be limited in clients with a history of addiction.

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 Explanation: The client should not receive morphine within 14 days of receiving an MOA inhibitor.

A 40-year-old male client with arthritis of the knee joint has been prescribed an analgesic to relieve the pain. Which medication is a narcotic analgesic?

Morphine Explanation: Morphine is a narcotic analgesic. Aspirin, ibuprofen, and celecoxib are nonnarcotic analgesics. Aspirin is classified as a salicylate and ibuprofen as a nonsteroidal anti-inflammatory drug (NSAID). Celecoxib is a newer NSAID that acts by inhibiting the cyclo-oxygenase-2 (COX-2) enzyme.

The nurse notes a respiratory rate of 6 breaths/min in a client in the postanesthesia recovery unit. Which drug would the nurse anticipate being given immediately?

Naloxone Explanation: Naloxone has long been the drug of choice to treat respiratory depression caused by an opioid. Therapeutic effects occur within minutes after IV, IM, or sub-Q injection and last 1 to 2 hours. Butorphanol would worsen respiratory depression. Acetaminophen and diphenhydramine are used to treat headache. Epinephrine may be prescribed for an allergic reaction but not for respiratory depression.

A client is admitted to the emergency department for an opioid overdose. What would the nurse expect to administer to this client?

Naloxone Explanation: Naloxone is the drug of choice for opioid overdose.

The pathophysiology of pain begins with a signal from what source?

Nociceptors Explanation: For a person to feel pain, the signal from nociceptors in peripheral tissues must be transmitted to the spinal cord, then to the hypothalamus and cerebral cortex in the brain. Myelin sheaths, synapses, and baroreceptors are not directly involved in pain transmission.

A client is prescribed zolmitriptan for migraine headaches. The nurse should instruct the client to administer this drug by which route?

Oral Explanation: Zolmitriptan is administered by either the oral route or intranasally. It is not currently available by either a transdermal patch or subcutaneous injection.

A client diagnosed with cluster headaches should be educated to expect which therapies for this condition?

Oxygen Subcutaneous injection of sumatriptan Explanation: Treatment for cluster headaches involves subcutaneous sumatriptan and oxygen. Nonsteroidal anti-inflammatory drugs, beta adrenergic antagonists, and antibiotics are not used for cluster headaches.

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

Postoperative acute respiratory depression Suspected or known acute opioid overdosage Adverse effects related to opioid administration Explanation: Opioid antagonists are used for the treatment of acute respiratory depression, overdosage, and adverse effects of opioid administration. Administration often counters the pain-relieving effects of an opioid medication and does not enhance opioid effects. These are not actions of an opioid antagonist.

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. Explanation: Naproxen should be taken on a full stomach. The pills should not be crushed. Constipation is not a noted adverse effect, and regular blood work is not warranted.

A nurse is caring for a client who required an opioid antagonist. Which should the nurse confirm to ensure that administration of the opioid antagonist is not contraindicated in the client?

The client is not hypersensitive to the opioid antagonist. Explanation: The nurse should confirm that the client is not hypersensitive to the opioid antagonist to ensure that its administration is not contraindicated in the client. Elevated blood pressure is an adverse reaction of opioid antagonists, but administration of these drugs is not known to be contraindicated in clients with high blood pressure. Opioid antagonists are used cautiously in clients who are lactating and in clients who have cardiovascular disease, but presence of these conditions does not contraindicate the use of opioid antagonists.

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. Explanation: The client may begin to demonstrate symptoms of withdrawal when he or she has a history of opioid abuse and is administered an opioid antagonist. The other answers are incorrect. In fact, clients will likely have increased pain due to antagonistic effects of the drug. The standard dosage and a single dose will be administered even with a history of opioid abuse.

The nurse is planning abortive therapy for a client who experiences migraines. What goal should the nurse prioritize?

The client will obtain rapid relief of migraine symptoms. Explanation: Abortive therapy is the administration of medications to treat the symptoms of migraine headache. Drugs for abortive therapy are not taken on a regularly scheduled basis. Prevention and identification of causative factors are important, but these are not directly related to abortive therapy.

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 Explanation: Patient response to morphine depends on the route of administration and the dosage.

A family member of a client in the emergency department reports that the client has been illegally using fentanyl. The nurse should prioritize assessment of what vital sign to assess for overdose?

respiratory rate Explanation: All the client's vital signs are important areas of assessment. However, opioids have a profound effect on respiratory rate, and this is a priority assessment.

Morphine, the prototype drug for opioid analgesics, is given for both acute and chronic pain. The patient's response to the drug depends on the:

route of administration. Explanation: Morphine, the prototype, is a naturally occurring opium alkaloid used mainly to relieve severe acute or chronic pain. Patient response depends on route of administration and dosage. Generally speaking, when deciding on a dosage range for a specific patient, the patient's insistence on the drug is not a factor. The patient's gender and disease process are also not factors.

The nurse is educating a young adult client diagnosed with migraine headaches about the prescribed acetaminophen-aspirin-caffeine combination for abortive therapy. Which statement made by the client establishes the need for further clarification?

"I can take my over-the-counter cold remedies in addition to this drug for cold symptoms." Explanation: The nurse needs to clarify the statement that the client made regarding planning to take over-the-counter (OTC) cold remedies because the preparations usually contain acetaminophen, aspirin, or caffeine. The nurse should always teach clients to consult a pharmacist to prevent potential drug interactions or overdoses of same or similar ingredients found in various OTC preparations. The other statements are correct. Caffeine leads to vasoconstriction; this helps stop the migraine, which results from vasodilation of the vessels. The medication is contraindicated during pregnancy and breast-feeding. Consuming foods or drinks high in caffeine would increase risk for restlessness, tremors, tachycardia, hypertension, and palpitations from extra irregular heartbeats.

The nurse is providing education to a client on safe administration of prochlorperazine. What teaching point should the nurse include?

"Take the pill whole; do not crush or split it." Explanation: When taking prochlorperazine orally, it is important to swallow it whole and not chew or crush the tablets. Blood work is not warranted, and there is no need to avoid fatty food prior to taking the drug. Prochlorperazine is not noted to cause hypotension.

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." Explanation: Administer sumatriptan as soon as the headache begins. Sumatriptan is more efficacious when given before the headache escalates. However, it is not normally taken on a prophylactic basis.

A client with a history of migraines has been prescribed sumatriptan. What education should the nurse provide about the safe and effective use of this drug?

"Take your medication as soon as you first sense a migraine coming." Explanation: Sumatriptan is taken at the first sign of a migraine. It is not normally taken on a regular basis, so taking it with meals or at bedtime is unnecessary. Grapefruit juice is not contraindicated.

A female client is crying and states that everyone thinks she is a "drug addict," and that no one will listen to her. She states she has abdominal pain and must have something for the pain. What is the best response of the nurse?

"Tell me more about your pain." Explanation: Nurses must lessen the barriers to good pain management by showing sensitivity to the client and conducting a through assessment. The nurse needs to encourage the client to share information regarding pain so that an appropriate treatment plan can be designed. To do this open ended statements need to be made. Questions with yes/no responses are not as therapeutic. Nurses must demonstrate nonjudgmental attitudes with clients.

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 Explanation: Since 1 mL contains 10 mg of morphine, the nurse will administer 0.25 mL to deliver 2.5 mg of morphine (2.5 mg ÷ 10 mg/mL = 0.25 mL)

A hospice client has been prescribed morphine 5 mg sub-Q every 2 hours. The medication vial reads "10 mg/mL." How many milliliters will be administered?

0.5 mL Explanation: 5 mg/X = 10 mg/mL. The calculation results in 0.5 mL. The administration of 0.25, 1, or 2 mL is incorrect.

The nurse enters the client's room to see how the client's pain level is because PRN Demerol can be given. The client is sitting up in bed laughing and visiting with family. The client states that the pain is a "10" on a pain scale of 0 to 10. What is the best response by the nurse?

Administer the pain medication as ordered. Explanation: Pain is what the client says it is. If the client states pain is a "10" and is requesting medication, the nurse should medicate as per orders. The client laughing and visiting may be a method of coping with the pain. The nurse should demonstrate a nonjudgmental attitude to build a trusting relationship. The nurse cannot alter the dosage of medication without consulting the health care provider.

A nurse is caring for a client with renal impairment. The client has been prescribed an opioid analgesic. Which nursing intervention would be most appropriate?

Consult with the prescriber about lowering the dosage of the drug. Explanation: The nurse should lower the dosage of the drug when caring for a client with renal impairment who has been prescribed an opioid analgesic, but only after consulting with the prescriber and obtaining a prescription to do so. The nurse has to provide an aggressive bowel program to clients who experience an adverse reaction on their GI system due to the action of the opioid analgesics. Use of an antacid is recommended only if prescribed by the primary health care provider under specific circumstances. The nurse need not administer the drug through the IV route for a client with renal impairment who has been prescribed opioid analgesics.

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. Explanation: 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.

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

Fentanyl (Duragesic) Explanation: Naloxone (Narcan) is an opioid antagonist, which means it will only reverse the effects of opioids like fentanyl (Duragesic).

The client tells the nurse that the health care provider described a drug as having "no ceiling effect." How should the nurse respond when the client asks what that means?

It is a valuable drug to use because dosage can be increased to relieve pain when pain increases or tolerance develops. Explanation: A drug with no ceiling effect is one in which there is no upper limit to the dosage that can be given to clients who have developed tolerance to previous dosages. This characteristic is especially valuable in clients with severe cancer-related pain because drug dosage can be increased and titrated to relieve pain when pain increases or tolerance develops. None of the other statements explain the terminology.

Pentazocine is a narcotic agonists-antagonist that is used in several different ways. However, pentazocine must be administered cautiously to what population?

Patients with known heart disease Explanation: Pentazocine must be administered cautiously to patients with known heart disease because the drug may cause cardiac stimulation including arrhythmias, hypertension, and increased myocardial oxygen consumption, which could lead to angina, MI, or congestive heart failure.

A male client is given regular doses of morphine for a period of 6 months. His dosage now needs to be reduced gradually. The health care provider advises the nurse to pay attention to the clinical management of the client's pain to allow proper agonist coverage during the change in drug dosage. Why is the client likely to suffer unnecessary pain and discomfort if proper management is not ensured?

Physical dependence on the drug Explanation: If morphine use lasts longer than 3 months, then physical dependence will occur. Dependence is characterized by a withdrawal or abstinence syndrome when morphine is discontinued; it represents an exaggerated rebound from its acute effects. Physical dependence is not the same as tolerance or addiction. Tolerance means that the body has become accustomed to the effects of a substance and that the client must use more of it to achieve the desired effect, while addiction involves compulsive use of the drug for a secondary gain, not for pain control.

A female client states that her pain is unbearable. The nurse has an order for one or two tablets of an opioid analgesic for pain relief. What is the best method that the nurse may use to assess the intensity of the pain?

Use a numerical scale of 0 to 10, with 0 being the least amount of pain. Explanation: Because pain is a subjective experience and cannot be objectively measured, assessment of intensity or severity is based on the client's description and the nurse's observations. Various scales have been developed to measure and quantify pain. These include verbal descriptor scales, in which the client is asked to rate pain as mild, moderate, or severe; numeric scales, with 0 representing no pain and 10 representing severe pain; and visual analogue scales, in which the client chooses the location indicating the level of pain on a continuum.

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 Explanation: A pain rating scale is the most reliable method because it provides measurable evidence of pain severity. A client's description of pain is useful, but does not provide objective or quantifiable data over time. Although percussing or palpating provides information, it would increase the client's pain and be inappropriate. Vital sign changes occur for numerous reasons and are not the best indicator of pain in clients who can speak.

A female client tells the nurse that the first thing she does when she gets a headache is drink a caffeinated beverage. The nurse is aware that caffeine is known to decrease the pain of migraine headaches by what mechanism?

Vasoconstriction of blood vessels Explanation: Caffeine causes vasoconstriction of blood vessels. This helps treat migraine headaches because migraine headaches are caused by vasodilation of cerebral vessels.

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. Explanation: The primary reason for administering an opioid antagonist is because the client is experiencing respiratory depression. Therefore, the goal is to improve the client's respiratory rate, rhythm, and depth. None of the other options is part of the drug therapy.

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. Explanation: Nociceptic pain is caused by the activation of the delta and C nociceptors in response to painful stimuli, such as injury. The sensation of pain is not the result of potassium release, though this does occur in cases of tissue trauma. The release of GABA inhibits pain. Pain is not the result of injury to the afferent fibers themselves, though these fibers transmit pain signals.

A 30-year-old client experiences migraines that appear closely linked to her menstrual cycle. What pharmacologic treatment is most specific to this client's particular experience of migraines?

estradiol Explanation: Estrogen in the form of estradiol is a treatment specific to menstrual migraines, which are most likely 2 days prior to menses through the third of bleeding. Adjuvants (such as chlorpromazine) and other abortive treatments (such as ergotamine and almotriptan) may be indicated, but these are not specific to menstrual migraines.

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 Explanation: Many nursing diagnoses likely apply to this client's situation, but there is evidence that she grieves her inability to perform a caregiving role for her grandchildren. There is no evidence that the client's health maintenance is inadequate or that she has low self-esteem. Spiritual distress is also not in evidence.

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

inhibiting the transmission of pain signals from peripheral tissues to the brain Explanation: Opioids relieve pain by binding to opioid receptors in the brain, spinal cord, and peripheral tissues. Opioids inhibit the transmission of pain signals from peripheral tissues to the brain, reducing the perception of pain sensation in the brain, producing sedation, and decreasing the emotional upsets often associated with pain. They do not inhibit signals from the hypothalamus. Nor do they increase endorphin production.