Pharmacology- PrepU chapter 49
A postsurgical client has been provided with a morphine patient-controlled analgesic (PCA) but has expressed reluctance to use it for fear of becoming addicted. How can the nurse best respond to this client's concerns?
"It is not uncommon to develop a dependence on pain medications, but this usually takes place over a long period and is not the same as addiction."
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
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
A family member asks the nurse why a second dose of an opioid antagonist is needed. Which response by the nurse is correct?
The opioid medication that was given may last longer than the opioid antagonist medication
A client with a viral respiratory infection has an intense headache and cough. What drug will best address both of this client's symptoms?
codeine
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"
A client is in the hospital recovering from surgery and is using a client-controlled anesthisia (PCA) pump. The client's adult child tells the nurse they are concerned about the possibility of morphine overdose because their parent keeps pressing the button on the PCA. In addition to reassessing the client's pain, what is the nurse's best response?
"The device has maximum limits programmed, so your parent cannot get more than a specific amount."
The nurse administers morphine 15 mg oral solution to a client with cancer pain at 09:30. What time should the nurse reassess the client for peak analgesic effect?
10:30
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
The nurse is caring for four clients. For which client would the nurse question the health care provider's order of IV morphine?
A 78-year-old with osteoarthritis
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
A client has been taking morphine PO for several months following a back injury. The care team is working with the client to wean the client off morphine. The client reports he is getting minimal relief from the pain with the new nonopioid medication he is receiving. What action should the nurse prioritize for this client?
Assess for signs of withdrawal syndrome
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
A client is to receive a narcotic that will be applied transdermally. The nurse identifies this as which agent?
Fentanyl
Naloxone (Narcan) will reverse the effects of which drug?
Fentanyl (Duragesic)
Which medication order should a nurse question?
Fentanyl PO 1 mg q4 hours for a 6-year-old in severe pain after surgery
A nursing instructor is preparing a teaching plan for a nursing class on opioid analgesics. Which body system would the nursing instructor describe as not adapting to and compensating for the secondary effects of this class of drugs?
GI system
Although naloxone is given to counter opioid medication side effects such as respiratory depression, what additional issues (if any) may result from administration of an opioid antagonist?
Increase in the client's pain rating
The pediatric nurse is providing care for several clients who are experiencing pain. The nurse should anticipate that clients may be ordered what narcotic analgesics? Select all that apply.
Morphine, meperidine, hydrocodone
The nurse is caring for a client who is receiving a prescribed opioid analgesic. What reactions that could be related to the drug therapy should prompt the nurse to contact the health care provider immediately? Select all that apply:
Respiratory rate of less than 10 breaths/min Decrease in pulse Blood pressure of 95/65 mmHg
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.
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
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
A client who is receiving an opioid develops a slowed breathing pattern due to the drug's effect of somnolence and pain relief. When providing care to this client, which would be most important for the nurse to do?
coach the client to breathe
A nurse monitoring a client taking an opiate for diarrhea should notify the health care provider immediately if what occurs? Select all that apply:
blood is noted in the stool, diarrhea worsens, client reports severe abdominal pain, diarrhea is not relieved
A patient is receiving drugs through a PCA infusion pump. Which of the following information should a nurse offer to the patient for proper administration of the drug through the infusion pump?
control button activates administration of the drug
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 diagnosed with impaired renal function has been prescribed morphine. How will the client's underlying condition affect the pharmacokinetics of the drug?
duration of action will be prolonged
The nurse is caring for a client who has been admitted to the emergency department after a fall. An x-ray indicates that the client has fractured his ankle. Because of a previous stroke, the client does not speak. What other method will the nurse use to assess this client's pain? (Select all that apply.)
facial expressions, movement of arms and hands, guarding of the leg
Naloxone will reverse the effects of which drugs? Select all that apply.
fentanyl and codeine
A nurse will be prepared to administer naloxone (Narcan) to a patient who has had an overdose of morphine. Repeated doses of Narcan will be necessary because Narcan
has a shorter half-life than morphine
A nurse should not administer an opioid antagonist to a client with which finding?
hypersensitivity to naloxone
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
The nurse is caring for a patient who is receiving an opioid analgesic. What would be a priority assessment by the nurse?
level of consciousness and respiratory rate
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
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
A client who was recently diagnosed with cancer is now receiving morphine for pain. Since this client has been receiving morphine for only a short time, he is best described by which term?
opiate naive
Opioid antagonists may produce withdrawal symptoms in clients physically dependent on which substance?
opioids
Which of the following terms would the nurse expect health care professionals to use to describe drugs used in pain management?
opioids
A geriatric client received a narcotic analgesic before leaving the postanesthesia care unit to return to the regular unit. What is the priority nursing intervention for the nurse receiving the client on the regular unit?
put side rails up and place bed in low position
An 80-year-old man has been prescribed oxycodone for severe, noncancer, chronic pain. He tells the nurse that he has difficulty swallowing and asks if he can crush the tablet before swallowing. The nurse will advise the client that:
there is risk of an extremely high dose available all at once if the tablet is crushed
After obtaining the history of a client who is prescribed opioid therapy, the nurse determines that the client is opioid naive. The nurse would be especially alert for which effect after the client receives the prescribed opioid?
respiratory depression
Keith, 12 years old, is seen in the emergency department for a severe sunburn. He reports pain, which he rates 7/10. What type of pain is he suffering from?
superficial somatic pain
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
Clients diagnosed with chronic pain should be given what information regarding opioids' effectiveness?
they should be given on a regular schedule, around the clock
A nurse is caring for two clients who are status postoperative for abdominal surgery. What is the best way to evaluate pain response after administering analgesia?
use a pain assessment tool before and 30 minutes after medication 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
