PrepU: Chapters 49, 52, 58

The patient asks how caffeine will help a migraine headache. How should the nurse respond?

"Caffeine causes constriction of blood vessels."

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.

Which of the following refers to the reduction in a drug's effect that follows persistent use?

tolerance

Which drug would be classified as a hallucinogen?

PCP

A woman who has just found out she is pregnant states she has "always taken sumatriptan for her migraines." What is the best advice for the nurse to give this patient?

"Ask your healthcare provider what other medications you can take."

While the school nurse is providing health education to a group of children on the dangers of illicit drug use, a child asks the nurse what sniffing gasoline or glue does to the body. What response is most effective in addressing this question?

"Doing that damages the brain and other body organs."

An adult resident of an assisted living facility has a history of migraines and has a prescription for sumatriptan, administered PRN. Before the client takes a dose, the nurse should ask what question to ensure the client's safety?

"Have you recently taken any other medications to treat this migraine?"

What statement indicates the patient needs more teaching about administering sumatriptan subcutaneously?

"I can take this medication safely when pregnant."

A client with a diagnosis of migraines has been prescribed ergotamine tartrate 1-2 mg sublingual followed by 1-2 mg every 30 min until migraine resolves. Which client statement would warrant follow-up and additional education provided by the nurse?

"I chew and swallow the tablets so I get relief as quickly as possible."

A client with a long-standing history of heroin abuse has expressed a motivation to stop using heroin permanently. The health care provider has prescribed methadone therapy in addition to a counseling and support program. What statement by the client should the nurse follow up with additional teaching?

"I need to obtain an adequate supply of methadone if I'll be going out of town for more than a couple of days."

A female client calls the clinic and states she has been taking propranolol for the last week to help decrease the incidence of migraine headaches. The client states that there has been no decrease in the number of headaches yet. What is the nurse's best response?

"It may take up to 3 months to know whether this medication will be effective in preventing your migraine headaches."

A client who has been experiencing headaches tells the nurse that she often takes an over-the-counter acetaminophen, aspirin, and caffeine medication. The client states, "I'm careful to never exceed the recommended dose, but I take one or two Tylenol if I don't get relief." What is the nurse's best response?

"It's best to avoid combining those medications so they don't harm your liver."

The family of a client withdrawing from heroin asks a nurse why the client is receiving naltrexone (ReVia). Which response is correct?

"It's used to help reverse withdrawal symptoms."

The nurse is talking with a patient who is in the hospital from complications related to alcoholism. The patient states, "My father and grandfather were alcoholics. Do you think this is why I am?" What is the best response by the nurse?

"Many studies say that certain genes can cause alcoholism."

The nurse is caring for a client who had abdominal surgery 1 day ago. The client is reluctant to get up and ambulate because of the pain. The nurse encourages the client to take the prescribed medication (morphine sulfate) and then ambulate with assistance. The client refuses because of fear of becoming addicted to the medication. What is the nurse's best response to this client?

"Most people who receive pain medications because of a medical reason don't become addicted to the medication."

A patient with a cluster headache reports that the health care provider did not prescribe anything but "air." What is the nurse's best response to this statement?

"Oxygen therapy has been shown to help relieve cluster headaches."

A client has sought care for the treatment of migraines that have become increasingly severe. The care provider has prescribed abortive therapy. What should the nurse teach the client about this drug regimen?

"Take your medication at the first sign of a migraine."

A 12-year-old patient presents to the clinic with migraines. The mother states, "I would like her to have sumatriptan, as that is the drug that helps me the most." What is the best information for the nurse to give the mother?

"The triptans are not usually prescribed for children, because safety has not been established."

A patient with frequent migraines has been prescribed valproic acid for her migraine. What should the nurse teach the patient?

"This medication is taken daily."

A client has taken sumatriptan and does not feel it is working. The client wants to know when more medication can be administered. Which response should the nurse prioritize?

"You can take a second dose 2 hours after the first."

A hospital client is reporting pain, and the health care provider has prescribed 3 mg hydromorphone SC. The medication is available in single-use vials of 10 mg/1 mL. How many milliliters of hydromorphone should the nurse draw up? Record the answer using 1 decimal place.

0.3

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

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 client has been diagnosed with Parkinson's disease and the primary health care provider has prescribed levodopa(100 mg)-carbidopa(10 mg) PO q8h. What is the nurse's best action?

Administer the medication as prescribed and monitor for therapeutic and adverse effects

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

A client is experiencing an exacerbation of migraines and has been prescribed metoclopramide 20 mg IV. The nurse has consulted the parenteral drug therapy manual and added the medication to a 50 mL minibag of normal saline. The manual states that the drug may be administered over 15 minutes. At what rate should the nurse administer the medication?

200 ml/hr

A client has been admitted with a suspected overdose of lorazepam and has been prescribed an initial dose of flumazenil 0.2 mg IV STAT with 0.3 mg on standby, pending the client's response to the initial dose. The nurse obtains a vial of the medication at 0.1 mg/mL and will draw up the initial dose and the repeat dose. What total volume of flumazenil should the nurse draw up?

5

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 patient with frequent migraines is having her diet evaluated. What foods may precipitate the patient's migraines? Select all that apply.

Aged cheese Fermented foods Diet soda with aspartame

The hospital nurse is responding to a code blue where a client is believed to have overdosed on an unknown opioid. The team administered naloxone 2 mg IV to the client 2 minutes ago with no appreciable improvement in respiratory function or level of consciousness. What is the nurse's most appropriate action?

Anticipate the immediate administration of another 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?

Ask for pain medication before the pain gets severe.

To decrease the risk of injury to a client taking an opioid, what should the nurse do? (Select all that apply.)

Assist client from their bed to the toilet. Assist client with rising from a lying position. Assist client with hall-walking activities.

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

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 0 to 10.

Which of the following street drugs would be classified as a hallucinogen? Select all that apply.

LSD Ecstasy Angel dust

The nurse has just administered an opioid antagonist medication. Which side effect might the nurse anticipate that the client will experience? (Select all that apply.)

Nausea and vomiting Tremors Sweating

A client diagnosed with a substance use disorder asks the nurse why it is necessary to attend counseling in addition to taking the prescribed medication. What statement should inform the nurse's response?

Plans that combine methods of therapy are typically more successful.

A client is 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.

A female client's health care provider orders an ergot preparation for her migraine headaches. The nurse is responsible for the education plan. What would be the nurse's teaching regarding how the client is to take her medication?

Take it at the onset of a headache, and lie down in a quiet, darkened room.

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.

A client was prescribed oral hydromorphone two weeks ago for the treatment of cancer pain. The client was able to achieve pain relief with 2 mg doses for the first 10 days, but has recently needed 3-4 mg to achieve the same effect. The client has expressed concern to the nurse that he is becoming addicted to hydromorphone. What should the nurse teach the client?

The client is developing a tolerance, which is not the same as addiction.

A family expresses concern when a family member withdrawing from alcohol is given lorazepam (Ativan). What information should be given to the family about the medication?

The medication is given for a short time to help the client complete the withdrawal process

The patient tells the nurse, "I have been having to take more and more of my pain medication to alleviate this pain in my back. It is not working as well as it was." What does the nurse understand is occurring with the medication?

The patient has developed a tolerance to the medication and requires more medication to get the same effect.

The nurse is caring for a client for whom a psychological therapy has been ordered to assist with recovery from an addictive disorder. The nurse understands that what statement is true about psychological rehabilitation efforts?

They should be part of any treatment program for a drug-dependent person.

Charlie, a homeless heroin addict, has been admitted into care and needs immediate intervention. A visiting health care provider has begun Charlie on methadone maintenance. What fact should the nurse consider during this client's treatment for substance use?

Using methadone maintenance may lead to a dependence on methadone.

A male client is diagnosed with chronic renal failure. He routinely takes amantadine for his Parkinson's disease with success. Why would his health care provider consider discontinuing the amantadine?

With amantadine, excretion is primarily via the kidneys.

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 nurse is caring for a client with migraines. The prescriber orders subcutaneous sumatriptan. What type of treatment is this medication considered?

abortive

The nurse is caring for a patient with a migraine. What nursing diagnosis is a priority?

acute pain

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 nurse is giving instructions to a client who has just been prescribed sumatriptan for the treatment of migraine headaches. The client will be instructed to take this medication at what time?

at the onset of migraine symptoms

The client is taking digitalis and has not been monitoring pulse rate. The client presents to the emergency department via ambulance experiencing digitalis toxicity and symptomatic bradycardia. The nurse knows that which medication may be administered to treat bradycardia?

atropine

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

blood pressure

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

As a school nurse, you are preparing to do a presentation on cannabis and the long-term sequelae of its heavy use. To what body system or function do you understand cannabis use can cause the most damage?

brain

A client is experiencing acute alcohol withdrawal. What medication does the nurse anticipate the prescriber to order?

chlordiazepoxide

Administration of which classes of medications can decrease secretions of the upper respiratory tract?

cholinergic blocking drug

A client has had symptoms of a migraine headache approximately 2 to 3 days per week for the last 3 months. The nurse is aware that this client has developed what condition?

chronic migraine headache

A client with chronic pain was prescribed oxycodone several months ago and has developed a tolerance, requiring gradual increases in dose. As well, the client admits to experiencing psychological dependence and is showing signs and symptoms of physical dependence. The nurse should advocate for what approach?

close monitoring and gradual tapering down of the dose

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 28-year-old patient comes into the emergency department with chest pain. The client's blood pressure is 170/108, heart rate 116, and respiratory rate 32. The client states having "used drugs." The nurse would question the client about the use of:

cocaine

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

codeine

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

Which of the following medications are used as an alcohol deterrent?

disulfiram (antabuse)

Which neurotransmitter is most likely responsible for the rewarding and reinforcing effect of cocaine?

dopamine

A nurse has admitted a client diagnosed with substance abuse intoxication to the unit. The nursing assessment will first be directed toward data regarding:

drug use

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

A client is to receive a narcotic that will be applied transdermally. The nurse identifies this as which agent?

fentanyl

An older adult 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 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

The nurse is assessing a client who takes benzodiazepines for the treatment of anxiety disorder. The client has presented nonresponsive and the client's partner reports he has recently taken oxycodone recreationally. The nurse should place the highest priority on what assessment?

respiratory function

A nurse is working in the emergency department and is assigned to a client brought in by family members. The family thinks that the client is on methamphetamine. The nurse should assess for:

hypertension

Ergotamine tartrate is a drug used in the treatment of migraines. Cafergot is a mix of ergotamine tartrate and caffeine. What effect of caffeine aids in the treatment of migraines?

it increases vasoconstriction

Disulfiram is sometimes prescribed to maintain sobriety in patients with alcoholism. Which of the following statements accurately describes the effect of taking disulfiram?

it interferes with hepatic metabolism of alcohol

What nursing intervention would not be effective in assisting the client in stopping his or her migraine headache?

keeping the room well lit

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

The nurse is caring for a client who has received a prescription for naproxen sodium for the treatment of migraine headaches. This client also takes lithium carbonate for bipolar disorder. The nurse is aware that this client will be monitored for what condition?

lithium toxicity

A nurse is caring for a patient with cancer who has been prescribed dronabinol (Marinol) to help reduce nausea and vomiting from chemotherapy. The nurse will inform the patient that he or she is taking an oral form of

marijuana

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

Which of the following medication is a narcotic antagonist?

naloxone (narcan)

A patient comes to the clinic asking for help to quit drinking alcohol. She has a 21-year history of heavy drinking and is worried about developing cirrhosis of the liver. The patient agrees to take disulfiram (Antabuse). The nurse will teach the patient that the combination of alcohol and Antabuse will cause which of the following?

nausea

The nurse is caring for a client who received naloxone to treat opioid toxicity. Which assessment findings will the nurse identify as adverse effects of this medication? Select all that apply.

nausea tremors sweating drowsiness

Which client would the nurse identify as being opioid naive?

one who does not routinely take opioids

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

A client is prescribed dicyclomine. The nurse would expect to administer this drug by which route?

oral

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 patient who is in severe pain and is receiving an opioid analgesic. Which of the following would be the nurse's priority assessments?

pain intensity, respiratory rate, and level of consciousness

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 assigned to care for a 40-year-old patient with a hepatic injury that has occurred due to the administration of tolcapone. Which interventions should the nurse perform when caring for this patient?

perform regular blood tests of the patient

The nurse is providing care for a client physically dependent on an opioid. How is physical dependence best characterized?

physiologic adaptation that results in unpleasant symptoms when the drug is stopped

What beta-adrenergic antagonist is used for migraine prophylaxis?

propanolol

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

Paramedics have brought a client to the emergency department with a suspected heroin overdose. The nurse should recognize that the client's most acute threat to health at this time is:

respiratory depression

During his assessment, Drew reveals that he is a frequent user of crack and has been on a binge for several days. The nurse realizes that he requires frequent cardiac assessments. The reason for this increased assessment of the cardiac system is because of the major risk for what condition as a result of crack cocaine use?

rupture of the aorta

Which anticholinergic agent is sometimes used to manage motion sickness when delivered by transdermal patch?

scopolamine

Which of the following is a clinical manifestation of alcohol withdrawal?

seizures

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

What client should not receive a nonsteroidal anti-inflammatory medication as ordered for migraine relief?

the client with a gastric ulcer

What statement is correct concerning the use of sumatriptan (Imitrex) for migraine headache relief?

the medication causes vasoconstriction

What is essential for the nurse to assess prior to the patient taking sumatriptan-naproxen sodium (Treximet)?

the patient's cardiac history

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 patient is receiving chlorpromazine hydrochloride (Thorazine) for migraine headache. What will the nurse teach the patient about this therapy?

this medication is an antiemetic as well as a pain medication