Chapter 26: Narcotics, Narcotic Antagonists and Antimigraine Agents
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? urine specific gravity. skin integrity. bowel patterns. core body temperature.
bowel patterns
Pain may be classified according to: region, intensity, and duration. age, gender, or cause. location, intensity, and medical history. origin, duration, or cause.
origin, duration, or cause. Pain may be classified according to origin in body structures (e.g., somatic, visceral, neuropathic), duration (e.g., acute, chronic), or cause (e.g., cancer). Region, age, gender, and medical history are not included in pain classifications.
The nurse works in a long-term care facility. When administering narcotics to clients, the nurse must monitor for which side effect? Diarrhea Bleeding Sleep deprivation Constipation
Constipation Morphine and other opiates delay stomach emptying and slow peristalsis. They can be used to treat severe diarrhea or for surgical interventions involving the intestines. However, this slowed peristalsis can also cause constipation (a very common side effect), abdominal pain, and distention. Sleep deprivation, bleeding and diarrhea are not normal side effects.
A 57-year-old client is given morphine for myocardial ischemic pain. The nurse needs to monitor the client frequently for which adverse effect? Sweating Decreased respiratory rate Urinary retention Dizziness
Decreased respiratory rate The most hazardous adverse effects of morphine relate to excessive CNS depression; they include respiratory depression, hypoventilation, apnea, respiratory arrest, circulatory depression, cardiac arrest, shock, and coma. The most frequent adverse effects of morphine and other agonist narcotics are respiratory depression, apnea, bradycardia, light-headedness, dizziness, sedation, nausea and vomiting, and sweating.
A client's family asks why the nurse has placed suction equipment in the room immediately after administering a dose of naloxone (Narcan). Which explanation by the nurse is correct? After surgery, a client may feel nauseated as a side effect of the anesthesia. Abrupt reversal of opioid-induced respiratory depression may cause vomiting. This is a precaution in case the client begins to choke when resuming a general diet. Suction equipment should be placed in all client rooms as a standard of care postoperatively.
Abrupt reversal of opioid-induced respiratory depression may cause vomiting. It is important to keep suction equipment readily available because abrupt reversal of opioid-induced respiratory depression may cause vomiting. None of the other rationales provided is a valid reason for adding suction equipment to the room of a client who requires a dose of naloxone.
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? urine specific gravity. skin integrity. bowel patterns. core body temperature.
bowel patterns. 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 57-year-old client is given morphine for myocardial ischemic pain. The nurse needs to monitor the client frequently for which adverse effect? Sweating Decreased respiratory rate Urinary retention Dizziness
decreased respiratory rate
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? Antibiotic Antihypertensive Monoamine oxidase (MAO) inhibitor NSAID
MAOIs
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? Aspirin Ibuprofen Celecoxib Morphine
Morphine 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.
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
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 a dose of sumatriptan each morning when you suspect there's a chance of having a migraine." "Take this drug as soon as you feel the first signs of a migraine." "Lie down when you feel a migraine coming on and take some sumatriptan around 30 minutes later." "Take a dose of sumatriptan after you feel that you're unable to endure the pain of your migraine."
"Take this drug as soon as you feel the first signs of a migraine." 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 who is receiving morphine reports nausea after every dose of medication. What is the nurse's best response to this client? "I'm sorry. That means you won't be able to have any more pain medication." "This is a common side effect of the medication. I will try to make sure you have something to eat when you take the morphine." "I will mark your chart that you are allergic to morphine." "I will ask the health care provider if I can give you acetaminophen for the pain instead of the morphine."
"This is a common side effect of the medication. I will try to make sure you have something to eat when you take the morphine."
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. Reassess pain level in one hour. Administer half of the prescribed pain medication. Tell the client he does not look like he needs any pain medication.
Administer the pain medication as ordered. 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 client is to receive a narcotic that will be applied transdermally. The nurse identifies this as which agent? Morphine Fentanyl Codeine Hydromorphone
Fentanyl Fentanyl is available as a transdermal patch.
Naloxone (Narcan) will reverse the effects of which drug? Fentanyl (Duragesic) Lorazepam (Ativan) Valproic Acid (Depakote) Warfarin (Coumadin)
Fentanyl (Duragesic) Naloxone (Narcan) is an opioid antagonist, which means it will only reverse the effects of opioids like fentanyl (Duragesic).
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? Abdominal pain Respiratory depression Fever Nervousness
Respiratory depression The nurse should closely monitor the patient for respiratory depression after insertion of the epidural catheter and throughout the therapy. Patients using epidural analgesics for chronic pain are monitored for respiratory problems with an apnea monitor. The patient may also experience sedation, confusion, nausea, pruritus, or urinary retention. The nurse need not monitor the patient for abdominal pain, fever, and nervousness because they do not occur as a result of the administration of epidural analgesia.
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? Heart rate Respiratory rate Temperature Pulse
Respiratory rate The first sign of narcotic overdose is often respiratory depression. Therefore, monitoring the client's vital signs, particularly respirations, is extremely important when administering narcotics.
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 women 85 years of age
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 Oxycodone Oxymorphone Tramadol
methadone
