Karch's PrepU (Pharm) Ch. 26 Narcotics
The nurse observes that a new client's medication regimen includes sumatriptan. What assessment should the nurse prioritize? Assessing the client for migraine pain Assessing the client for narcotic withdrawal syndrome Assessing the client for respiratory depression Assessing the client's lying, sitting and standing blood pressure
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.
To decrease the risk of injury to a client taking an opioid, what should the nurse do? (Select all that apply.) Keep the lights in the client's room turned down. Assist client from their bed to the toilet. Assist client with rising from a lying position. Assist client with hall-walking activities. Advise the client to stay in bed all night.
Assist client from their bed to the toilet. Assist client with rising from a lying position. Assist client with hall-walking activities. Explanation: To decrease the risk of injury to a client taking an opioid, the nurse should assist the client with ambulatory activities and with rising from a sitting or lying position. The nurse should also keep the client's room well-lit during daytime hours, keep the client's room free of clutter, and advise the client to seek assistance when getting out of bed at night.
A client suffering from migraine headaches is prescribed sumatriptan. What is the action of the drug? Binding to phospholipids to diminish anxiety Interrupting the calcium intake in the neuron Binding to serotonin to produce vasoconstriction Reducing inflammation in the temporal arteries
Binding to serotonin to produce vasoconstriction Explanation: Sumatriptan binds to the serotonin receptors in the intracranial blood vessels, resulting in vasoconstriction. Sumatriptan does not bind to phospholipids to diminish anxiety. Sumatriptan does not interrupt the calcium intake in the neuron. Sumatriptan does not reduce inflammation in the temporal arteries.
The nurse works in a long-term care facility. When administering narcotics to clients, the nurse must monitor for which side effect? Sleep deprivation Bleeding Constipation Diarrhea
Constipation Explanation: 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.
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? The medication can be very irritating to mucous membranes. The crushed medication can permanently stain teeth. Crushing the medication may precipitate an overdose. Crushing the medication interferes with its absorption.
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.
A client has been administered an opioid. For what effect should the nurse regularly assess? Oliguria Level of consciousness (LOC) Edema Tachycardia
Level of consciousness (LOC) Explanation: Opioids will produce decreased LOC. Oliguria is not a result of the administration of an opioid. Edema is not a result of the administration of an opioid. Tachycardia is not a result of the administration of an opioid.
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? Tolerance to the drug Physical dependence on the drug Addiction to the drug Adverse effects of the drug
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.
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 0.5 mL 1 mL 2.5 mL
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 hospital client is reporting pain, and the provider has prescribed 3 mg hydromorphone SC. The medication is available in single-use vials of 10 mg/1 mL. How many milliliter of hydromorphone should the nurse draw up? Record your answer to the nearest tenth.
0.3 Explanation: The nurse should divide 3 mg by 10 mg/mL, resulting in 0.3 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 many mL will the nurse administer to the client?
0.5 Explanation: If there is 0.4 mg in 1 mL and the nurse wishes to give 0.2 mg, then the nurse should withdraw 1/2 of 1 mL or 0.5 mL.
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 Explanation: 6 mg ÷ 10 mg/mL = 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 10 to 15 minutes 15 to 30 minutes 30 to 60 minutes
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.
The nurse knows that, of the following clients, who is least likely to be prescribed transdermal fentanyl? A man 25 years of age A woman 85 years of age A man 50 years of age A woman 35 years of age
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.
A client's healthcare provider has prescribed meperidine 75 mg PO q4h PRN for the client's chronic pain. What education should the nurse provide to this client regarding this medication? "Avoid drinking alcohol while taking meperidine." "Have blood levels drawn in one week." "Avoid sun exposure, or apply high-SPF sunscreen." "Eat small, frequent meals to reduce gastrointestinal upset."
"Avoid drinking alcohol while taking meperidine." Explanation: Drinking alcohol during narcotic treatment can exacerbate CNS depression. Narcotics do not necessitate monitoring of serum levels and they do not cause photosensitivity. Most clients do not experience significant dyspepsia; constipation is by far the most common GI effect.
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 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.
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 Explanation: 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.
Which assessment finding would support a client's report of migraine headaches? Severe unilateral pulsating pain Sharp steady eye pain Dull band of pain around the head Onset occurring during sleep
Severe unilateral pulsating pain Explanation: Migraine headaches are associated with severe unilateral pulsating pain on one side of the head. Sharp steady eye pain with an onset usually during sleep is associated with cluster headaches. A dull band of pain around the head suggests a tension headache.
The nurse reviews a client's medication administration record before giving a new medication. For which medication would the nurse question giving the client a dose of tapentadol? metformin vitamin D3 St. John's wort vitamin B complex
St. John's wort Explanation: Tapentadol is an opioid agonist used to relieve moderate to severe neuropathic pain. There is a risk of serotonin syndrome if it is combined with St. John's wort. Tapentadol can be safely taken with metformin and other vitamin supplements such as vitamin D3 and vitamin B complex.
The nurse administers hydromorphone IV to the postoperative client as prescribed. What is the best method for the nurse to evaluate the client's response to the medication? Observe the client's behavior without the client's awareness, 30 minutes after administration. Use a pain assessment tool before and 30 minutes after administration. Assess the client's vital signs before and after drug administration. Ask the client if the medication has been effective.
Use a pain assessment tool before and 30 minutes after administration. Explanation: A standard pain assessment tool should be used both pre- and postanalgesia. This type of data is more accurate than asking the client a yes/no question about the effectiveness of the medication. The nurse should observe the client's response, but this does not provide the most accurate assessment data. Similarly, vital signs should be monitored, but trends do not necessarily demonstrate effectiveness.
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 Asking a client to describe his or her pain Percussing or palpating the area where pain is identified Assessing the client's vital signs
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.
The nurse administers an opioid analgesic to a client. When assessing for therapeutic effects, the nurse will perform which action? Observe the client when they are unaware of the assessment. Assess the client's respiratory rate and oxygen saturation. Using a pain scale, ask the client to describe the pain. Ask the client whether they are still in pain.
Using a pain scale, ask the client to describe the pain. Explanation: Asking the client to describe the pain using a pain scale is the most effective assessment of pain response and is more accurate than a yes/no question about being in pain. Observing the client when they are unaware is an objective assessment and does not represent a true pain experience. Respiratory assessment focuses on adverse effects, not therapeutic effects.
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. management of alcohol withdrawal symptoms. a reduction in the client's rating of their pain. alertness and improve memory function.
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 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. 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.
The nurse is describing potential adverse effects to a client who has been prescribed an opioid agonist. The nurse would indicate that effects on what body system(s) are potentially life threatening? Select all that apply. gastrointestinal (GI) central nervous (CNS) genitourinary respiratory renal
central nervous (CNS) respiratory Explanation: Sedation from CNS depression and respiratory depression are major adverse effects and are potentially life threatening. Opioids are not generally responsible for life-threatening effects on the other body systems.
Which conditions would occur due to the administration of an opioid antagonist in a client who is physically dependent on opioids? drowsiness hypotension withdrawal symptoms insomnia
withdrawal symptoms Explanation: Opioid antagonists produce withdrawal symptoms in clients who are physically dependent on opioids. Drowsiness, hypotension, and insomnia do not occur in opioid-dependent clients who are administered opioid antagonists.
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? 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. Explanation: 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.
The client is having surgery this week. What information should the nurse give the client concerning the use of pain medication after surgery? Take as little pain medication as possible to prevent addiction. Ask for pain medication before the pain gets severe. Request your pain medication whenever it is available to you. Wait as long as possible for pain medication; it will work more effectively.
Ask for pain medication before the pain gets severe. Explanation: The nurse should emphasize the importance of pain control, stressing to the client that pain relief is greater if the medication is taken when pain is not very severe. If the client waits too long for pain medication, it will be much harder to control the pain. Also, the client should not take pain medication whenever it is available, but only when it is needed. It is rare for a client to become addicted to pain medication when it is taken for the relief of pain. The need for the pain medication goes away when the pain subsides.
A clint's past experience with pain has little impact on the patient's perception of pain. True False
False Explanation: Past experience with pain has a large impact on how pain is perceived.
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
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? Aspirin Ibuprofen Celecoxib Morphine
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.
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? Vital signs Pain scale Glasgow coma scale Subjective assessment
Pain scale Explanation: The method the nurse should prioritize in this situation is using the pain scale. Following the administration of the acetaminophen-aspirin-caffeine combination, the client should exhibit diminished pain. The nurse assesses for pain using the pain scale. A subjective assessment would involve more than just the pain scale. Assessing vital signs would be an objective assessment and not necessarily confirm therapeutic effects The Glasgow coma scale would not be indicated for migraine headache.
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 lactating. The client does not have high blood pressure. The client is not hypersensitive to the opioid antagonist. The client does not have a cardiovascular disease.
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? During pain assessment, the client may report less pain. The client may begin to demonstrate symptoms of withdrawal. Double the standard dosage of the medication may be needed. Multiple doses may be needed to be therapeutic.
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.
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 patient's insistence on receiving the drug The patient's gender The route of administration The patient's disease process
The route of administration Explanation: Patient response to morphine depends on the route of administration and the dosage.
The nurse administered a scheduled dose of hydromorphone to a client 30 minutes 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 Explanation: Narcotics such as hydromorphone should reduce the client's pain and a certain degree of respiratory depression nearly always occurs. However, this should not affect the client's oxygen saturation level. Temperature is not normally affected. Drowsiness is very common, but the client would not be expected to become disoriented.
A nurse should not administer an opioid antagonist to a client with which finding? hypersensitivity to naloxone uncontrolled type 2 diabetes history of opioid abuse history of alcohol abuse
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.
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 health maintenance related to migraine headaches ineffective role performance related to migraine headaches situational low self-esteem related to migraine headaches spiritual distress related to migraine headaches
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.
A nurse has just administered an IM injection of meperidine (Demerol) to an elderly client. The priority nursing action for the nurse would be which? close the draperies. make sure the side rails are up. check the temperature of the room. make sure the client is positioned comfortably.
make sure the side rails are up. Explanation: The priority nursing action will be to make sure that the side rails are up. Meperidine can cause dizziness and sedation, which increase the risk of the client falling. The side rails should be up to remind the client that she should not get out of bed without help. Closing the draperies, checking the temperature of the room, and making sure the client is comfortable creates an environment that will enhance the efficacy of the medication therapy but are not the priority actions.
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. Explanation: Respiratory depression is a common adverse effect of morphine. If the client gets a cold, as the nasal congestion can be a sign, this respiratory depression could cause retained secretions and put the client at greater risk for developing pneumonia. The drug does not cause myocardial infarction or renal impairment. A common cold is not known to cause hypersensitivity to the morphine.
Morphine has been prescribed for a 28-year-old man with severe pain due to a back injury. The nurse is teaching the client upon discharge to avoid alcohol while taking this medication because it can cause which? respiratory depression over stimulation of the back muscles kidney pain urinary retention
respiratory depression Explanation: The nurse should advise the client to avoid alcohol and any other CNS depressants while taking morphine. These combinations can cause serious respiratory depression and sedation. Over stimulation of back muscles, kidney pain and urinary retention are not know effects of this interaction.
A client with a history of migraines has been prescribed sumatriptan and is experiencing relief. What physiologic response is the client most likely experiencing? vasoconstriction of cranial blood vessels increased synthesis and release of endorphins stimulation of A-delta stimulation of C fibers
vasoconstriction of cranial blood vessels Explanation: Sumatriptan binds to serotonin receptors to cause vasoconstrictive effects on cranial blood vessels. It does not directly influence endorphin levels. Stimulation of A-delta and C fibers causes increased, not decreased, pain levels.
A client with a history of migraines has been prescribed sumatriptan and is experiencing relief. What physiologic response is the client most likely experiencing? vasoconstriction of cranial blood vessels increased synthesis and release of endorphins stimulation of A-delta stimulation of C fibers
vasoconstriction of cranial blood vessels Explanation: Sumatriptan binds to serotonin receptors to cause vasoconstrictive effects on cranial blood vessels. It does not directly influence endorphin levels. Stimulation of A-delta and C fibers causes increased, not decreased, pain levels.
