PREPU UNFINISHED: Chapter 16: Opioid Antagonists
20 of 20 The client has had an opioid overdose. What order for naloxone would be appropriate for the nurse to administer for reversal of opioid effects? • 0.4 to 2 mg IV repeat every 2-3 minutes • 5 to 10 mg IV repeat every 5 minutes • 4 to 6mg IV repeat every 2 to 3 minutes • 0.1 to 0.2 mg IV repeat every 2 to 3 minutes
• 0.4 to 2 mg IV repeat every 2-3 minutes Explanation: 0.1 to 0.2 mg is given IV and then repeated every 2 to 3 minutes for reversal of opioid effects. If the client has overdosed on opioids the dose is much larger: 0.4 to 2 mg every 2 to 3 minutes.
1 of 5 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 • 15 to 30 minutes • 10 to 15 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.
16 of 20 The physician orders naloxone (Narcan) 0.4 mg IM to be administered to an average-sized client. The pharmacy sends naloxone 0.4 mg/mL. Which needle length will the nurse use to administer this medication? • 1 inch • 0.5 inch • 1.5 inch • 0.25 inch
• 1.5 inch Explanation: Because naloxone is to be administered intramuscularly, it is important to review the needle selection for correctly administering this medication. Intramuscular medications are to be administered using a 1.5 inch needle to successfully reach muscle tissue on an average-sized adult.
14 of 20 The nurse has administered an opioid antagonist to counteract the respiratory depression from an opioid. An initial set of vital signs are taken. What is the maximum amount of time in minutes the nurse should wait to reassess the client's vital signs?
• 5 Explanation: The nurse should reassess the client's vital signs no longer than 5 minutes after the client has taken an opioid antagonist to reverse respiratory depression. Of course, the nurse could reassess the client's vital signs sooner, and should if this is a postoperative setting.
7 of 10 The dosing for postoperative opioid reversal using nalmefene (Revex) is 0.25 mcg/kg, given in 2 to 5-min increments. What is the maximum dosage (mcg) a client weighing 60 kg could receive in 10 minutes?
• 75 Explanation: A client weighing 60 kg would receive 0.25 x 60 = 15 mcg per increment. A client could receive this medication in 2 minute increments and therefore could receive 5 doses in 10 minutes. 10 x 15 = 75 mcg.
11 of 20 Several people have recently undergone abdominal surgery, and each client will receive morphine sulfate for postoperative pain. Which client is at the greatest risk for respiratory depression as a result of taking morphine sulfate? • A client currently being treated with methadone for alcohol addiction • A 68-year-old client who takes codeine every once in a while for arthritic pain • A 30-year-old client who recently stopped taking hydrocodone (Vicodin) for a sinus infection • A 37-year-old client with no history of drug or opioid use
• A 37-year-old client with no history of drug or opioid use Explanation: The opioid-naive client is at the greatest risk for respiratory depression as a result of taking an opioid like morphine sulfate.
1 of 5 A nursing student demonstrates an understanding of the actions of opioid antagonists when making which statement? • A client who receives an opioid antagonist will also experience a reversal of pain relief. • An opioid antagonist is selective for specific adverse reactions. • A client who receives an opioid antagonist to reverse respiratory depression will still have pain relief. • An opioid antagonist has no effect on respiratory depression.
• A client who receives an opioid antagonist will also experience a reversal of pain relief. Explanation: An opioid antagonist is not selective for specific adverse reactions. When an antagonist is given for respiratory depression, it is important to remember that the antagonist reverses all effects. Therefore, a client who receives an antagonist to reverse respiratory effects will also experience a reversal of pain relief-that is, the pain will return. If the individual has not taken or received an opioid, an antagonist has no drug effect.
3 of 5 The nurse is caring for a postoperative client taking an opioid medication for pain. The nurse assesses the client to have bradypnoea and an oxygen saturation value of 90%. Which actions should the nurse perform before administering the ordered opioid antagonist? • Reassess the client's level of pain. • Reposition the client for comfort. • Call for a respiratory therapy consult. • Assess the client's other vital signs.
• 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.
9 of 20 A 39-year-old opioid-naive client has received morphine sulfate 5 mg IV. Ten minutes later, the nurse notices the client is sleepy and drowsy. What should the nurse do first? • Administer oxygen via face mask. • Notify the primary care physician. • Administer naloxone (Narcan) 2 mg via IV push. • Assess the client's vital signs.
• Assess the client's vital signs. Explanation: The first step in the nursing process is to assess. Therefore, the first thing the nurse should do in this instance is assess the client's vital signs, especially the respiratory rate.
17 of 20 After administration of an opioid antagonist, the nurse should perform which action? • Assess vital signs every five minutes until the client responds. • Conduct a pain assessment rating once every four hours and as needed. • Monitor the client's vital signs once every hour to assess effectiveness. • Obtain the client's oxygen saturation level once every four hours.
• Assess vital signs every five minutes until the client responds. Explanation: The client's vital signs should be assessed every five minutes until the client responds to the antagonist, and then every five to 15 minutes once they have responded. Once per hour is too long for vital signs and oxygen saturation assessment. While pain is an important nursing assessment, it is less critical than vital signs after respiratory depression has occurred.
13 of 20 A nurse has administered 2 mg butorphanol (Stadol) to a female client for postoperative pain. Five minutes after administration of the medication, the client's respiratory rate has decreased dramatically and she is sleeping. What should the nurse do first?
• Attempt to rouse the client Explanation: If the nurse suspects respiratory depression after the administration of an opioid, the best thing to do first is to attempt to rouse the client. The respiratory rate may decrease dramatically as the client shifts from anxiety related to pain to pain relief.
2 of 5 A nursing student indicates a need for further instruction on opioid antagonists when making which statement? • A client given an opioid for surgery who does not take this medication often is at risk for an adverse reaction. • Clients involved in long-term opioid therapy for pain build tolerance to the drug. • Clients who do not take opioids frequently are at risk for adverse effects. • Clients who do not take opioids frequently have more tolerance for them.
• Clients who do not take opioids frequently have more tolerance for them. Explanation: Patients involved in long-term opioid therapy for pain build tolerance to the physical adverse effects. It is the patient who does not use opioids routinely and who is being given an opioid drug for acute pain relief or a surgical procedure who is at most risk for respiratory depression.
2 of 10 A clent is administered the opioid antagonist naloxone (Narcan) for respiratory depression and a state of unresponsiveness. How does naloxone work? • Synergism • Tolerance • Breakthrough • Displacement
• Displacement Explanation: Naloxone (Narcan) is an opioid antagonist that works by displacement. Naloxone does not work by synergism, breakthrough, or tolerance.
4 of 5 What is the mechanism of action of naloxone (Narcan), an opioid antagonist? • Causes inhibition of ascending pain pathways • Produces generalized CNS excitation • Displaces opioids by more effectively binding to opioid receptor sites • Destroys opioids by adding an additional oxygen molecule and thus oxidizing them
• Displaces opioids by more effectively binding to opioid receptor sites Explanation: An opioid antagonist acts by more effectively binding to opioid receptor sites and thus competing with opioids for activation on a cell.
15 of 20 A full-term infant was born 1 minute ago and has a heart rate of 110 bpm, blue hands and feet, poor tone, and a feeble cry. What should the nurse do first? • Administer 0.1 mg of naloxone (Narcan). • Dry and stimulate the newborn. • Administer oxygen at 100% saturation. • Administer positive pressure ventilation.
• Dry and stimulate the newborn. Explanation: The first step in maintaining airway, breathing, and circulation is an initial attempt to rouse the patient. The best way to get an infant to respond and cry is to stimulate the baby by stroking the back.
7 of 20 The nurse has learned that when giving Narcan IV to reverse respiratory depression, the drug is given by slow IV push. This is done for which reason? • Giving it fast will cause withdrawal and return of the pain. • It may cause IV infiltration. • The drug handbook recommends to give IV slowly. • It will cause fewer interactions with other medications the client is receiving.
• Giving it fast will cause withdrawal and return of the pain. Explanation: When Narcan is used to reverse respiratory depression, the drug is given IV slowly until the respiratory rate begins to increase. If it is given quickly as a bolus, it will cause withdrawal and the return of intense pain. The drug handbook states to give it slowly, but that is not the rationale behind the action.
3 of 20 When evaluating the effects of a narcotic agonist-antagonist on a client, what adverse effect would the nurse monitor for? • Hypertension • Decreased pulse pressure • Hypotension • Increased pulse pressure
• Hypertension Explanation: Monitor for adverse effects (CNS changes, GI depression, respiratory depression, arrhythmias, and hypertension).
6 of 20 The nurse realizes that Narcan can be given in which of the following ways? (Check all that apply.) • IV secondary line • PO • SQ • IV piggyback • IV push
• IV secondary line • IV piggyback • IV push Explanation: If Narcan is given by IV infusion, the primary care provider orders the IV fluid, amount, dosage, and infusion rate. Giving the drug by IV infusion requires use of a secondary line, an IV piggyback, or an IV push. It is not given SQ or PO ever.
9 of 10 The client is receiving an opioid medication for pain. During an assessment, the nurse notes respiratory depression in the client. Which actions should the nurse perform next? Select all that apply. • Monitor the respiratory pattern until the opioid drug is metabolized. • Do nothing because no further action is required at this time. • Review the allergy and health histories and current treatment modalities. • Make an effort to arouse the client to change his breathing pattern if possible. • Review the medical record for which drug could be causing the symptom.
• Make an effort to arouse the client to change his breathing pattern if possible. • Review the medical record for which drug could be causing the symptom. • Review the allergy and health histories and current treatment modalities. Explanation: The first action upon noting respiratory depression should be to rouse the client to change his or her breathing pattern. The nurse should also review the medical record to determine which medication is the cause so that an appropriate opioid antagonist can be selected. It is also appropriate to review the initial health history, allergy history, and current treatment modalities. In the case of respiratory depression, an opioid antagonist should be ordered; therefore, taking no action and monitoring the client (or taking no action at all) could lead to worsening of the condition. These options are incorrect.
5 of 20 When giving Narcan to reverse the actions of an opioid, the nurse can give this only how many times? • No limit • May be repeated once if the primary care provider orders it • Once • Should never give narcan for this problem
• May be repeated once if the primary care provider orders it Explanation: The effects of some opioids may last longer than the effects of Narcan. A repeat dose may be ordered by the provider if results obtained from the initial dose are unsatisfactory. The duration and close observation of the patient depend upon the patient's response to the drug.
4 of 5 Which medications are opioids for which naloxone (Narcan) may be given to counter the effects? • Ibuprofen (Motrin) • Naproxen (Aleve) • Acetaminophen (Tylenol) • Meperidine (Demerol)
• Meperidine (Demerol) Explanation: Meperidine (Demerol) 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.
10 of 20 A 25-year-old client is brought to the Emergency Department via ambulance after overdosing on hydrocodone/acetaminophen (Vicodin). The client has a respiratory rate of 4 bpm. Which medications could be administered to reverse the respiratory depression? Select all that apply. • Naloxone (Narcan) • Methadone • Morphine sulfate • Nalmefene (Revex) • Hydromorphone (Dilaudid)
• Naloxone (Narcan) • Nalmefene (Revex) Explanation: Naloxone and nalmefene are opioid antagonists. Morphine, hydromorphone, and methadone are opioids and would not be given to a client experiencing an overdose of opioids.
16 of 20 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.) • Sweating • Tremors • Nausea and vomiting • Bradycardia • Decreased blood pressure
• Nausea and vomiting • Tremors • Sweating Explanation: Listed side effects of opioid antagonists include nausea, vomiting, tremors, and sweating. Other side effects include increased blood pressure and tachycardia. The other answers are opposite effects of known side effects, such as increased blood pressure and tachycardia, and are therefore incorrect.
9 of 20 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 • Opiate agonistic • Opiate tolerant • Opiate intolerant
• Opiate naive Explanation: An opiate tolerant client is one who, because of previous opioid use, has developed a drug tolerance. An opioid tolerant client typically requires a larger-than-usual dose for pain relief. Conversely, an opiate naive client has not received sufficient opioids for development of tolerance. The client described in the scenario is opiate naive.
8 of 10 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.) • Suspected or known acute opioid overdosage • Reduction of acute postoperative surgical site pain • Enhancement of an opioid analgesic physiologic effect • Postoperative acute respiratory depression • Adverse effects related to opioid administration
• 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.
2 of 20 A nurse is caring for a client who receives an opioid antagonist through the IV route. The client is experiencing acute pain. Which would be most important for the nurse to do when monitoring and managing the client's acute pain? • Review circumstances that led to the use of an opioid antagonist. • Administer the drug IV through a rapid bolus. • Monitor the client's blood pressure and pulse frequently for changes. • Reduce the dose administered to the client according to prescription.
• Review circumstances that led to the use of an opioid antagonist. Explanation: When monitoring or managing acute pain in a client who receives an opioid antagonist, the nurse should review the circumstances that led to the need for the antagonist. When the antagonist is administered through the IV route, the drug should be administered via a slow IV push. A rapid bolus will increase the pain experienced by the client. The nurse need not reduce the drug dose that is administered to the client in case the client experiences pain. Although monitoring blood pressure and pulse is an important assessment, it is not essential because the client's respiratory status was the reason for the antagonist.
18 of 20 Which equipment should be placed in the client's room when administering an opioid antagonist? (Select all that apply.) • A cardiac monitor to assess the client's cardiac function • A pulse oximeter to monitor the client's oxygen saturation levels • Extra pillows to help reposition the client for comfort • A different opioid medication to replace the drug being countered • Suction equipment in case the client begins to vomit
• Suction equipment in case the client begins to vomit • A cardiac monitor to assess the client's cardiac function • A pulse oximeter to monitor the client's oxygen saturation levels Explanation: A cardiac monitor, ventilator, suction equipment and a pulse oximeter are all valid pieces of equipment to manage side effects from administration of the opioid antagonist. An alternative opioid medication would be contraindicated and it should not be placed in the room. Pillows for repositioning the client are not critical items needed specific to opioid antagonist administration.
5 of 5 Which adverse reactions may occur as a result of administering an opioid antagonist? • Decreased blood pressure and decreased pulse • Increased temperature and decreased oxygen saturation • Sweating, tachycardia, and increased blood pressure • Diarrhea, cramping, and increased pain rating
• Sweating, tachycardia, and increased blood pressure Explanation: Side effects of opioid antagonists include nausea and vomiting, sweating, increased blood pressure, and tremors. All other side effects listed are not side effects of opioid antagonists.
18 of 20 The client is brought to the emergency department in respiratory arrest after overdosing on heroin. The person accompanying the client says he has been using heroin for years. After being administered one dose of naloxone, the client begins to breathe spontaneously but remains nonresponsive to stimuli so another dose is prescribed. The nurse should monitor for what signs and symptoms of acute narcotic abstinence syndrome? Select all that apply. • Vomiting • Bradypnea • Tachycardia • Hypertension • Sedation
• Tachycardia • Hypertension • Vomiting Explanation: The most common adverse effect is an acute narcotic abstinence syndrome that is characterized by nausea, vomiting, sweating, tachycardia, hypertension, tremulousness, and feelings of anxiety. Bradypnea and sedation are not associated with acute narcotic abstinence syndrome.
10 of 20 If a client is given an opioid antagonist without having taken an opioid, what will happen? • The client will experience effects as if he or she had taken an opioid. • The antagonist will have no effect on the client. • The client will experience enhanced adverse effects of the opioid antagonist. • The client will first experience enhanced adverse effects of the opioid antagonist and then effects as if he or she had taken an opioid.
• The antagonist will have no effect on the client. Explanation: Because an opioid antagonist reverses the effects of an opioid, if the client has not ingested an opioid, it will not have an effect.
19 of 20 A client presents to the emergency department with symptoms of an acute opioid overdose. The primary health care provider orders naloxone for the client. Several minutes after administration, the client's respiratory depression and other symptoms have not changed. This is most likely due to which mechanism? • The client is not experiencing an opioid overdose. • The client overdosed on multiple opioids. • The client was not administered a large enough dose of naloxone. • The naloxone has not been given enough time to work.
• The client is not experiencing an opioid overdose. Explanation: The nonimprovement in client symptoms may be because the client is not experiencing an opioid overdose but may have overdosed on a nonopioid substance, such as a benzodiazepine. If the client has not taken or received an opioid, an opioid antagonist has no drug effect. The dose would have followed a prescribed dosage; therefore, a large enough dose would have been given. The naloxone would have been beneficial even if there were more than one opioid used. The naloxone effects can be seen within 1 to 2 minutes.
2 of 5 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 does not have high blood pressure. • The client is not hypersensitive to the opioid antagonist. • The client is not lactating. • 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.
12 of 20 The half-life for naloxone (Narcan) administered intravenously is 60 minutes. The half-life of morphine sulfate administered intravenously is 90 to 120 minutes. What may happen to a client who was given naloxone IV for respiratory depression as a result of taking morphine sulfate IV? • The client may need a repeat dose of naloxone. • The client may need a repeat dose of morphine sulfate. • As naloxone wears off, the client will experience a return of pain. • Naloxone will exacerbate the effects of morphine, causing severe respiratory depression.
• The client may need a repeat dose of naloxone. Explanation: Because the half-life of naloxone is shorter than morphine sulfate, the client may need a repeat dose of the naloxone to continue to prevent respiratory depression.
12 of 20 A 21-year-old mother just gave birth to her second child after a difficult labor. Which newborn has the highest likelihood of needing naloxone (Narcan) at birth? • The newborn of a mother who received butorphanol (Stadol) 10 hours prior to delivery. • The newborn of a mother who received morphine sulfate 1 hour prior to delivery. • The newborn of a mother who has been taking methadone during her pregnancy. • The newborn of a mother who has been taking heroin during her pregnancy.
• The newborn of a mother who received morphine sulfate 1 hour prior to delivery. Explanation: The newborn of the mother taking methadone or heroin during her pregnancy would not need naloxone but instead suffer opioid withdrawal symptoms. The mother who received butorphanol remote from delivery would have the medication out of her system by the time of birth. The mother who received morphine sulfate 1 hour prior to delivery would have the highest likelihood of having a newborn that needed naloxone because the opioid would still be in the newborn's circulation and could cause respiratory depression.
19 of 20 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 antagonist is not a very high dose, so more than one dose is needed to have an effect. • Depending on the client's metabolism, multiple doses may be required to have an effect. • The opioid medication that was given may last longer than the opioid antagonist medication. • When a client is on multiple medications, more opioid antagonist is needed to be effective.
• The opioid medication that was given may last longer than the opioid antagonist medication. Explanation: The duration of an opioid medication may exceed the length of action of an opioid antagonist, thus requiring multiple doses to have a therapeutic effect. The other answers are incorrect because they are not true statements.
11 of 20 The client has had an opioid overdose. Prior to the administration of an opioid antagonist the client's vital signs are 100/50, P40, respirations 6, and afebrile temperature. How would the nurse evaluate that the medication has been therapeutic? • The respiratory rate is 8 bpm. • The client is awake and able to speak. • The client's blood pressure is 80/50. • The client feels warm and is pale.
• The respiratory rate is 8 bpm. Explanation: An increase in the respiratory rate would indicate that the medication was effective. The nurse would also expect the heart rate to increase as well as the blood pressure. The level of consciousness can vary client to client.
13 of 20 When teaching a client about the action of an opioid antagonist, what should the nurse include in the education? • An opioid antagonist acts on the central nervous system to elevate the level of consciousness. • This medication competes with the opioid pain medication, binding to the cell receptors instead. • An antagonist increases the rate of respirations to counter the effects of the opioid medication. • A medication called an opioid antagonist is given to enhance the effect of the opioid.
• This medication competes with the opioid pain medication, binding to the cell receptors instead. Explanation: This medication competes with the opioid pain medication by binding to the cell receptors where the opioid would attach. One of the options describes the effect of an adjuvant medication, not an antagonist. The other answers are incorrect because what is listed is not the action of an opioid antagonist.
17 of 20 Opioid antagonists such as naloxone (Narcan) should be used cautiously in clients with which conditions? Select all that apply. • Women who are breastfeeding an infant • Clients who have been administered anesthesia • Women who are pregnant • Children in the postoperative period • Infants of opioid-dependent mothers
• Women who are pregnant • Infants of opioid-dependent mothers • Women who are breastfeeding an infant Explanation: Antagonists are contraindicated in those with a hypersensitivity to the opioid antagonists. Antagonists are used cautiously in those who are pregnant (pregnancy category B), in infants of opioid-dependent mothers, and in clients with an opioid dependency or cardiovascular disease. These drugs also are used cautiously during lactation. Opioid antagonists are safe to administer to children and clients who have been given anesthesia.
1 of 20 A client presents to the ED with symptoms of a acute opioid overdose. The health care provider orders naloxone (Narcan) for the client. Several minutes after the nurse administers the naloxone, the client's respiratory depression and other symptoms have not changed. This is most likely because the: • client was not administered a large enough dose. • client is not experiencing an opioid overdose. • naloxone (Narcan) has not been given enough time to work. • client overdosed on multiple opioids.
• client is not experiencing an opioid overdose. Explanation: The non-improvement in client symptoms may be due to the fact the client is not experiencing an opioid overdose, but may have overdosed on a non-opioid substance, such as a benzodiazepine. If the client has not taken or received an opioid, an opioid antagonist has no drug effect.
5 of 20 In the PACU the nurse must take into consideration which before giving pain medicine to the postoperative client? • type of surgery and type of pain medicine • type of pain and cost of pain medicine • type of pain medicine and length of surgery • continued pain relief and client's ability to breathe
• continued pain relief and client's ability to breathe Explanation: The PACU nurse frequently uses Narcan postoperatively. As the client awakes from the deep operative sleep, the nurse must balance the need for continued pain relief against the person's ability to breathe independently after the surgery. The others are not a concern of the PACU nurse.
1 of 20 As part of the ongoing assessment of a client during administration of an opioid antagonist, the nurse would monitor the client's blood pressure, pulse, and respiratory rate at which frequency until the client responds? • every 60 minutes • every 30 minutes • every 5 minutes • every 15 minutes
• every 5 minutes Explanation: As part of the ongoing assessment during the administration of the opioid antagonist, the nurse monitors the client's blood pressure, pulse, and respiratory rate at frequent intervals, usually every 5 minutes, until the client responds. Any longer time will not be a true ongoing assessment in this circumstance, and critical changes can occur if not monitored more closely.
10 of 10 Naloxone will reverse the effects of which drugs? Select all that apply. • warfarin • lorazepam • fentanyl • codeine • valproic acid
• fentanyl • codeine Explanation: Naloxone is an opioid antagonist, which means it will only reverse the effects of opioids like fentanyl and codeine. Lorazepam is a benzodiazepine, thus naloxone has no effect on it. Valproic acid is used in the treatment of seizures and is not an opioid. Warfarin is an anticoagulant used to prevent blood clots from forming.
5 of 5 A nurse should not administer an opioid antagonist to a client with which finding? • history of alcohol abuse • history of opioid abuse • uncontrolled type 2 diabetes • hypersensitivity to naloxone
• 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.
4 of 20 A nurse working in an alcohol detoxification clinic would expect to use which medication to treat clients with alcohol dependence? • naloxone • nifedipine • nevirapine • naltrexone
• naltrexone Explanation: Naltrexone is an opioid antagonist used for alcohol dependence. Naloxone is an opioid antagonist used to reverse respiratory depression. Nevirapine is an antiretroviral agent. Nifedipine is a calcium channel blocker.
7 of 20 A nursing student is studying opioids and how they can cause respiratory depression. The student correctly identifies which of the following as the drugs of choice to reverse respiratory depression? (Check all that apply.) • revex • fentanyl • versed • lidocaine • Narcan
• narcan • revex Explanation: Opioid antagonists are used for the treatment of respiratory depression and opioid reversal as well as suspected acute opioid overdose. The two common drugs in this class are narcan and revex. Fentanyl, versed, and lidocaine are medications used in anesthesia, but they cannot reverse respiratory depression or opioid overdose.
8 of 20 A client in the PACU is experiencing respiratory depression from opioids given during surgery. The physician orders which dosage of Narcan for the client? • 0.025 mcg/kg repeated in 2-5 minute increments • narcan 0.1-0.2 mg IV at 2-3 minute intervals • 25 mcg/kg repeated in 2-5 minute increments • narcan 1 to 2 mg IV at 2-3 minute intervals
• narcan 0.1-0.2 mg IV at 2-3 minute intervals Explanation: The correct dose for the client is narcan 0.1-0.2 mg IV at 2-3 minute intervals. The others are medication errors and never would be ordered for a client.
6 of 20 The nurse identifies which expected outcomes for a client who has been administered Narcan for respiratory depression? Select all that apply. • normal respiratory rhythm • normal respiratory rate • normal respiratory depth • normal BP • no pain
• normal respiratory rate • normal respiratory depth • normal respiratory rhythm Explanation: Expected outcomes for the client with respiratory depression are an optimal response to therapy and support of client needs. This is essentially a return to normal respiratory rate, rhythm, and depth. Being free of pain and having a normal blood pressure are not outcomes for managing this client. If the client has a history of hypertension, then the BP will usually remain elevated. Being free from pain is not a outcome when managing respiratory depression.
20 of 20 Which client would the nurse identify as being opioid naive? • one who does not routinely take opioids • one who is psychologically dependent on opioids • individual who is physically dependent on opioids • person who routinely takes opioids
• one who does not routinely take opioids Explanation: Opioid-naive clients are defined as those who do not use opioids or infrequently use them. Those who routinely take and are physically or psychologically dependent on opioids are not considered opioid naive.
4 of 20 A new graduate nurse lists which of the following as uses for opioid antagonists? (Check all that apply.) • suspected acute opioid overdosage • postoperative nausea • postoperative acute respiratory depression • pain control • opioid adverse effects (reversal)
• postoperative acute respiratory depression • opioid adverse effects (reversal) • suspected acute opioid overdosage Explanation: Opioid antagonists are used for the treatment of postoperative acute respiratory depression, opioid adverse effects (reversal), and suspected acute opioid overdosage.
3 of 20 If a client begins to experience somnolence after receiving an opioid, the first action the nurse should take is: • call an anesthetist. • notify the physician. • rouse the client and coach the breathing pattern. • administer an opioid antagonist.
• rouse the client and coach the breathing pattern. Explanation: Sometimes the somnolence (drowsiness) and pain relief produced by the opioid will slow the client's breathing pattern. The nurse should first make an effort to rouse the client and coach his or her breathing pattern. Then, before administering an antagonist, the nurse should obtain the blood pressure, pulse, and respiratory rate and review the record for the drug suspected of causing the respiratory depression. The other actions would be done at a later time if warranted.
2 of 20 While caring for a client who is prescribed an opioid antagonist for treatment of respiratory depression caused by opioid therapy, the nurse would assess the client for which adverse reaction? Select all that apply. • tremors • fever • nausea • tachycardia • diarrhea
• tachycardia • tremors • nausea Explanation: The nurse should monitor for tachycardia, tremors, and nausea in the client because these are the adverse reactions associated with the use of opioid antagonists. The other adverse reactions include sweating, vomiting, and increased blood pressure. The nurse need not monitor for fever or diarrhea because these are not adverse reactions caused by opioid antagonists.
3 of 5 The nurse understands that when administering Narcan to a client for respiratory depression, the client will experience abrupt pain. This is because: • Narcan causes excruciating pain at the site of administration. • the opioid no longer works in the body. • the client becomes more awake and therefore more aware of pain. • it is a psychological response.
• the opioid no longer works in the body. Explanation: When the antagonist drug is given to clients, they experience pain abruptly because the opioid no longer works in the body. The nurse should assess the pain level and begin to treat the pain again cautiously. It is not a psychological effect, nor does it cause pain at the IV site. The client may become more awake, but this is not the cause of the pain returning.
