Analgesics Homework Qs Flashcards
(141 cards)
1
Q
A nurse is teaching a female client who has a new prescription for transdermal sumatriptan to treat migraine headaches. Which of the following instructions should the nurse include?
A. “Take this medication daily to prevent headaches.”
B. “Activate the patch 30 minutes after application.”
C. “Use contraception while taking this medication.”
D. “You can bathe with the patch in place.”
A
C. “Use contraception while taking this medication.”
Sumatriptan can cause teratogenesis and should not be used during pregnancy
2
Q
Which information would the nurse include in the teaching plan for the client who is prescribed sumatriptan for migraine headache?
A. It should be administered when headache is at its peak.
B. It should be administered by deep intramuscular injection.
C. It is contraindicated in people with coronary artery disease.
D. Injectable sumatriptan may be administered every 6 hours as needed.
A
C. It is contraindicated in people with coronary artery disease.
In addition to promoting therapeutic cerebral vasoconstriction, sumatriptan promotes undesirable coronary artery vasoconstriction. Coronary vasoconstriction may cause harm to the client with coronary artery disease.
3
Q
The nurse is teaching a client with migraine headaches about almotriptan. Which statement by the client indicates that the teaching was effective?
A. “I will wait to take the medication until the pain has become unbearable.”
B. “I will take the medication as soon as I notice migraine symptoms.”
C. “If the first dose does not help, I can take two more doses 15 minutes apart.”
D. “I will take a dose every morning to make sure to prevent an acute attack.”
A
B. “I will take the medication as soon as I notice migraine symptoms.”
The drug is most effective when taken as soon as migraine symptoms start but before the onset of acute pain.
4
Q
The nurse is teaching a client with migraine headaches about almotriptan. Which statement by the client indicates that the teaching was effective?
A. “I will wait to take the medication until the pain has become unbearable.”
B. “I will take the medication as soon as I notice migraine symptoms.”
C. “If the first dose does not help, I can take two more doses 15 minutes apart.”
D. “I will take a dose every morning to make sure to prevent an acute attack.”
A
B. “I will take the medication as soon as I notice migraine symptoms.”
The drug is most effective when taken as soon as migraine symptoms start but before the onset of acute pain.
5
Q
A nurse is monitoring a client who took an overdose of acetaminophen 72 hr ago. The nurse should identify which of the following findings as a manifestation of acetaminophen poisoning?
A. Constipation
B. Xerostomia
C. Tinnitus
D. Vomiting
A
D. Vomiting
The nurse should expect a client who has acetaminophen poisoning to have early manifestations of nausea, vomiting, abdominal distress, diarrhea, and sweating.
6
Q
A nurse is teaching a client who takes acetaminophen daily to manage mild knee pain. The nurse should instruct the client to monitor for which of the following adverse reactions to this medication?
A. Tinnitus
B. Muscle pain
C. Hyperglycemia
D. Jaundice
A
D. Jaundice
Acetaminophen can cause hepatotoxicity. The client should monitor and report jaundice, abdominal pain, clay colored stools, and fever.
7
Q
When assessing an adolescent who recently overdosed on acetaminophen (Tylenol), it is most important for the nurse to assess for pain in which area of the body?
A. Flank.
B. Abdomen.
C. Chest.
D. Head.
A
B. Abdomen.
Acetaminophen toxicity can result in liver damage; therefore, it is especially important for the nurse to assess for pain in the right upper quadrant of the abdomen
8
Q
A client takes acetaminophen routinely. The nurse will advise the client to avoid which substance?
A. Alcohol
B. Caffeine
C. Diphenhydramine
D. Ibuprofen
A
A. Alcohol
Acetaminophen and alcohol are both hepatotoxic substances. Metabolites of acetaminophen, along with alcohol, can cause irreversible liver damage.
9
Q
A nurse in a clinic is talking with a client who has a new diagnosis of osteoarthritis. The nurse should anticipate that the client will require teaching about which of the following medications?
A. Acetaminophen
B. Celecoxib
C. Cyclobenzaprine
D. Ibuprofen
A
A. Acetaminophen
According to the American Pain Society, acetaminophen is the primary drug of choice for treating osteoarthritis.
10
Q
Which client statement indicates that teaching about acetaminophen is effective?
A. “I can drink beer with this but not wine.”
B. “I need to limit my intake of acetaminophen to 650 mg a day.”
C. “I should take an emetic if I accidentally overdose on acetaminophen.”
D. “I have to be careful about which over-the-counter cold preparations I take.”
A
D. “I have to be careful about which over-the-counter cold preparations I take.”
Many over-the-counter cold preparations contain acetaminophen; the amount of acetaminophen in cold preparations must be taken into consideration when the total amount of acetaminophen taken daily is calculated.
11
Q
A nurse has administered acetaminophen for pain relief to an infant. Based on the client’s development stage, which action is most important to include in the medication administration record?
A. The dose administered based on the client weight
B. The client pain level after administration of the medication
C. The time the dose was administered to the client
D. The client vital signs before the medication was administered
A
A. The dose administered based on the client weight
The most important action to document in the client’s medical record is the dose administered. The dose of acetaminophen administered to infants is based on weight.
12
Q
Which response would the nurse give to a client taking ibuprofen for rheumatoid arthritis who asks the nurse if acetaminophen can be substituted?
A. “Yes, both are antipyretics and have the same effect.”
B. “Acetaminophen irritates the stomach more than ibuprofen does.”
C. “Acetaminophen is the preferred treatment for rheumatoid arthritis.”
D. “Ibuprofen has anti-inflammatory properties, and acetaminophen does not.”
A
D. “Ibuprofen has anti-inflammatory properties, and acetaminophen does not.”
Acetaminophen is not a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs are preferred for the treatment of rheumatoid arthritis.
13
Q
Which medication is safest to take for pain in the week before a surgical procedure?
A. Naproxen
B. Aspirin
C. Ketorolac
D. Acetaminophen
A
D. Acetaminophen
Naproxen, aspirin, and ketorolac are nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) that are contraindicated for clients undergoing surgery
14
Q
Which medication DOES NOT increase the risk for upper gastrointestinal (GI) bleeding?
A. Aspirin
B. Ibuprofen
C. Acetaminophen
D. Methylprednisolone
A
C. Acetaminophen
Acetaminophen is a safe alternative to NSAIDs to reduce the risk of GI bleeding.
15
Q
A client develops tinnitus. Which of the client’s medications would the nurse suspect is the cause of this new development?
A. Digoxin 0.25 mg, one tablet daily
B. Aspirin 325 mg, two tablets every 4 hours
C. Captopril 25 mg, one tablet three times daily
D. Diphenhydramine 25 mg, one tablet every 4 to 8 hours prn
A
B. Aspirin 325 mg, two tablets every 4 hours
Aspirin is a salicylate. Extensive use of salicylates can cause salicylism. Tinnitus is a common manifestation of this condition.
16
Q
A client with arthritis takes large doses of aspirin. Which symptom would the nurse include when teaching the client about the clinical manifestations of aspirin toxicity?
A. Feelings of drowsiness
B. Disturbances in hearing
C. Intermittent constipation
D. Metallic taste in the mouth
A
B. Disturbances in hearing
Ringing in the ears occurs because of aspirin’s effect on the eighth cranial nerve and is a classic symptom of aspirin toxicity.
17
Q
A client who takes four 325-mg tablets of buffered aspirin four times a day for severe arthritis complains of dizziness and ringing in the ears. Which complication would the nurse conclude that the client probably is experiencing?
A. Salicylate (chemical of aspirin) toxicity
B. Allergic reaction
C. Withdrawal symptoms
D. Aspirin tolerance
A
A. Salicylate (chemical of aspirin) toxicity
Aspirin is a salicylate; excessive aspirin ingestion can influence the vestibulocochlear nerve (cranial nerve VIII), causing tinnitus and dizziness.
18
Q
The nurse is assessing the effectiveness of high dose aspirin therapy for an 88-year-old client with arthritis. The client reports hearing non-stop ringing in the ears. Which action should the nurse implement?
A. Refer the client to an audiologist for evaluation of her hearing.
B. Advise the client that this is a common side effect.
C. Notify the healthcare provider of the finding immediately.
D. Face the client directly and speak in a low, monotone voice.
A
C. Notify the healthcare provider of the finding immediately.
Tinnitus (ringing in the ears) is an early sign of salicylate toxicity. The healthcare provider should be notified immediately, and the medication discontinued.
19
Q
A nurse is teaching a client who has a new prescription for aspirin to prevent cardiovascular disease. Which of the following instructions should the nurse include in the teaching?
A. Take the tablets on an empty stomach.
B. Expect stools to turn black.
C. Anticipate the tablets to smell like vinegar.
D. Monitor for tinnitus.
A
D. Monitor for tinnitus.
Tinnitus is a manifestation of salicylism, or aspirin toxicity. Other manifestations include sweating, headache, and dizziness.
20
Q
The nurse is caring for a client who is receiving aspirin therapy. Which clinical indicator would be related to this therapy?
A. Urinary calculi
B. Atrophy of the liver
C. Prolonged bleeding time
D. Premature erythrocyte destruction
A
C. Prolonged bleeding time
Aspirin interferes with platelet aggregation, thereby lengthening bleeding time.
21
Q
A toddler ingested half a bottle of aspirin tablets. Which finding should the nurse expect to see in this child?
A. Dyspnea
B. Hypothermia
C. Edema
D. Epistaxis (nose bleed)
A
D. Epistaxis (nose bleed)
A large dose of aspirin inhibits prothrombin formation and lowers platelet levels. With an overdose, clotting time is prolonged. Spontaneous bleeding often occurs from the nose or mucous membranes in the mouth.
22
Q
The nurse is caring for a client that is taking prednisone and aspirin for rheumatoid arthritis. Which action by the nurse is appropriate for this client?
A. Assess the client’s pain level once a shift
B. Monitor the client’s temperature every two hours
C. Test the client’s stool for occult blood (blood in stool)
D. Apply a hot pack to a warm, acutely inflamed joint
A
C. Test the client’s stool for occult blood (blood in stool)
The client is at risk for gastrointestinal bleeding with the use of these two medications. The nurse should anticipate checking the stool for occult blood and monitor the client for signs and symptoms of anemia
23
Q
The client is using nonsteroidal anti-inflammatory drugs (NSAIDs) to manage arthritis pain. The nurse should caution the client about which potential side effect?
A. Urinary incontinence
B. Nystagmus
C. Constipation
D. Occult bleeding
A
D. Occult bleeding
Nonsteroidal anti-inflammatory drugs (NSAIDs) taken for long periods of time may cause serious side effects, including bleeding in the gastrointestinal tract.
24
Q
A child with juvenile idiopathic arthritis is prescribed nonsteroidal anti-inflammatory drug (NSAID) therapy at home. Which important toxic effect of NSAIDs would the nurse include in discharge instructions to the child and family?
A. Diarrhea
B. Hypothermia
C. Blood in the urine
D. Increased irritability
A
C. Blood in the urine
Hematuria may result from the use of NSAIDs because they may cause nephrotoxicity.
25
A nurse is caring for a client who has difficulty swallowing medications and is prescribed enteric-coated aspirin PO once daily. The client asks if the medication can be crushed to make it easier to swallow. Which of the following responses should the nurse provide?
A. "Crushing the medication might cause you to have a stomachache or indigestion."
B. "Crushing the medication is a good idea, and I can mix it in some ice cream for you."
C. "Crushing the medication would release all the medication at once, rather than over time."
D. "Crushing is unsafe, as it destroys the ingredients in the medication."
A. "Crushing the medication might cause you to have a stomachache or indigestion."
## Footnote
The pill is enteric-coated to prevent breakdown in the stomach and decrease the possibility of GI distress. Crushing the pill destroys that protection.
26
Which medication would the nurse anticipate the health care provider will prescribe to relieve the pain experienced by a client with rheumatoid arthritis?
A. Aspirin
B. Hydromorphone
C. Meperidine
D. Alprazolam
A. Aspirin
## Footnote
Because of its anti-inflammatory effect, acetylsalicylic acid is useful in treating arthritis symptoms.
27
Aspirin is prescribed on a regular schedule for a client with rheumatoid arthritis. The nurse understands that the medication is being used primarily for which property?
A. Analgesic
B. Antipyretic
C. Anti-inflammatory
D. Antiplatelet
C. Anti-inflammatory
## Footnote
The anti-inflammatory action of aspirin reduces joint inflammation.
28
A client has been given a prescription for acetylsalicylic acid/aspirin. The nurse recalls that this medication has which property?
A. Sedative
B. Hypnotic
C. Analgesic
D. Antibiotic
C. Analgesic
## Footnote
Acetylsalicylic acid (aspirin) acts as an analgesic by inhibiting production of inflammatory mediators.
29
A client who has a history of myocardial infarction (MI) is prescribed aspirin 325 mg. The nurse recognizes that the aspirin is given due to which of the following actions of the medication?
A. analgesic
B. anti-inflammatory
C. antiplatelet aggregate
D. antipyretic
C. antiplatelet aggregate
## Footnote
Aspirin is used to decrease the likelihood of blood clotting. It also is used to reduce the risk of a second heart attack or stroke by inhibiting platelet aggregation and reducing thrombus formation
30
A client is admitted to the emergency department with crushing chest pain. A diagnosis of acute coronary syndrome is suspected. Which medication is indicated to prevent progression to a myocardial infarction?
A. Aspirin
B. Atropine
C. Gabapentin
D. Epinephrine
A. Aspirin
## Footnote
Early administration of aspirin in the setting of acute myocardial infarction (MI) has been demonstrated to significantly reduce mortality.
31
The client with chronic arterial insufficiency of the legs refuses the prescribed dose of aspirin (ASA). The client states, 'My legs are not painful.' Which action will the nurse take?
A. Explain the reason for the medication and encourage the client to take it.
B. Withhold the medication at this time and return to check with the client again in 30 minutes.
C. Withhold the medication and tell the client to ask for it if the legs become uncomfortable.
D. Request that the client take the medication and explain that it prevents the client from being uncomfortable in the next few hours.
A. Explain the reason for the medication and encourage the client to take it.
## Footnote
The client needs information to make an educated decision. The client should receive information and support before making the decision to refuse the medication.
32
A client who recently had a heart attack has been prescribed low-dose (81 mg) aspirin at bedtime. The client states, “Why am I supposed to take a 'baby aspirin' instead of a regular 325 mg tablet?" Which statement represents the nurse's best response?
A. "Taking a higher dose will affect your hearing."
B. "The higher dose will cause you to have heartburn."
C. "Taking 325 mg of aspirin daily will increase your risk of bleeding."
D. "The higher doses may interfere with your normal sleep patterns."
C. "Taking 325 mg of aspirin daily will increase your risk of bleeding."
## Footnote
Lower-dose aspirin therapy is just as effective in reducing the risk of secondary heart attacks as higher doses of aspirin, but with less risk of bleeding (including gastrointestinal bleeding.)
33
How would the nurse instruct a client with arthritis to take aspirin when the client states that the aspirin causes stomach irritation?
A. An hour before a meal
B. With food and a full glass of water
C. With sodium bicarbonate
D. At the same time as the other medications
B. With food and a full glass of water
## Footnote
A full glass of water helps decrease gastric irritation by diluting the acidic substances in the stomach.
34
The nurse is teaching a group of clients diagnosed with arthritis about the use of non-steroidal anti-inflammatory agents (NSAIDs). In order to minimize side effects of these drugs, which action should the nurse emphasize?
A. Eat a diet high in fiber
B. Limit foods high in Vitamin K
C. Take the medication with food
D. Take the drug with an antacid
C. Take the medication with food
## Footnote
A common side effect of NSAIDs is gastrointestinal distress including heartburn, nausea, and stomach pain.
35
A health care provider prescribes aspirin for a client with severe arthritis. Which advice will the nurse provide to the client?
A. Take the medicine with meals.
B. See a dentist if bleeding gums develop.
C. Switch to acetaminophen if tinnitus occurs.
D. Avoid spicy foods while taking the medication.
A. Take the medicine with meals.
## Footnote
Acetylsalicylic acid is irritating to the stomach lining and can cause ulceration; the presence of food, fluid, or antacids decreases this response.
36
A nurse is caring for an older adult client who has rheumatoid arthritis (RA) and is taking aspirin 650 mg every 4 hours. Which of the following diagnostic tests should the nurse monitor to evaluate the effectiveness of this medication?
A. White blood cell (WBC) count
B. Rheumatoid factor (RF)
C. Antinuclear antibody (ANA)
D. Erythrocyte sedimentation rate (ESR)
D. Erythrocyte sedimentation rate (ESR)
## Footnote
ESR is useful in detecting and monitoring tissue inflammation in clients with RA. As the disease improves the ESR decreases.
37
A client with a history of heart disease has been prescribed prophylactic aspirin daily. Which action should the nurse implement to help prevent aspirin toxicity?
A. Monitor serum albumin
B. Measure daily protein intake
C. Assess serum potassium level
D. Teach the client that tinnitus is an expected side effect
A. Monitor serum albumin
## Footnote
Aspirin and salicylic acid are bound to serum albumin. A low serum albumin level may result in altered salicylate binding, thereby increasing the availability of unbound (active) drug for toxic effects.
38
The nurse educating a client who is postpartum about the use of ibuprofen for uterine cramping. Which statement should the nurse include in the teaching?
A. This medication could cause gastrointestinal discomfort
B. You may experience decreased vaginal discharge with this medication
C. Taking this medication could decrease your breast milk production
D. You could experience dizziness while taking this medication
A. This medication could cause gastrointestinal discomfort
## Footnote
Ibuprofen, which is an NSAID, can cause gastrointestinal upset, especially if taken frequently without food.
39
Which life-threatening complication may occur in clients taking high-dose or long-term ibuprofen?
A. Anaphylaxis
B. Gastrointestinal (GI) bleeding
C. Cardiac dysrhythmia
D. Disulfiram reaction
B. Gastrointestinal (GI) bleeding
## Footnote
Ibuprofen irritates the GI mucosa and can cause mucosal erosion while decreasing platelet activity, which can result in GI hemorrhage.
40
The nurse administers acetaminophen to a child who complains of pain after abdominal surgery. The mother asks the nurse why her child isn’t being given ibuprofen. Which response by the nurse is most appropriate?
A. 'It could prolong bleeding time.'
B. 'It’s contraindicated for young children.'
C. 'It can suppress the healing of the incision.'
D. 'It becomes ineffective when given for long periods.'
A. 'It could prolong bleeding time.'
## Footnote
Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID) prolongs bleeding time; in the postoperative period, medications that interfere with clotting and prolong bleeding are contraindicated.
41
Which therapeutic outcome would you NOT expect after administering ibuprofen?
A. Diuresis
B. Pain relief
C. Temperature reduction
F. Reduced inflammation
A. Diuresis
## Footnote
NSAIDs do not cause diuresis.
42
A nurse is reviewing prescriptions for a client with a history of rheumatoid arthritis and peptic ulcer disease. The client has prescriptions for ibuprofen and ranitidine. Which action will the nurse perform?
A. Clarify the prescription for ibuprofen
B. Administer the ibuprofen 30 minutes before the ranitidine
C. Hold the ranitidine for 1 hour after meals
D. Question the prescription for ranitidine
A. Clarify the prescription for ibuprofen
## Footnote
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that can cause gastrointestinal (GI) bleeding. The client has a history of peptic ulcer disease. The nurse should clarify the prescription for ibuprofen.
43
The mother of a toddler with hemophilia A (bleeding disorder) asks the nurse, 'Can I give my child ibuprofen for fever or pain?' How will the nurse respond?
A. 'Ibuprofen is a good choice for fever or pain.'
B. 'Give your child acetaminophen. Ibuprofen may cause bleeding.'
C. 'No. I’ll explain why your child isn’t allowed pain medications.'
D. 'You seem concerned about giving medications to your child.'
B. 'Give your child acetaminophen. Ibuprofen may cause bleeding.'
## Footnote
Ibuprofen is contraindicated because it interferes with platelet function and may cause more bleeding; therefore an analgesic such as acetaminophen should be administered because it does not interfere with coagulation.
44
A nurse is caring for a client who is to start therapy with ibuprofen for hip pain. Which of the following information should the nurse provide about ibuprofen?
A. Take the medication with an aspirin to increase effectiveness.
B. Take the medication with food.
C. Taking the maximum dose will offer stroke prevention.
D. Sustained-release forms may be crushed for easier administration.
B. Take the medication with food.
## Footnote
To minimize gastric irritation, the nurse should instruct the client to take ibuprofen with food, water, or milk.
45
A nurse is teaching a client who has a new prescription for ibuprofen to treat hip pain. Which of the following instructions should the nurse include in the teaching?
A. Expect ringing in your ears.
B. Take the medication with food.
C. Store the medication in the refrigerator.
D. Monitor for weight loss.
B. Take the medication with food.
## Footnote
To minimize gastric irritation, the client should take ibuprofen with food or immediately after a meal.
46
A nurse is evaluating a client who takes naproxen for pain associated with osteoarthritis. Which documented statement indicates the expected outcome was met?
A. Decreased erythema noted to joints
B. Muscle strength 3/5 to lower extremities
C. Client observed with steady gait upon ambulation
D. Deep tendon reflexes +3
C. Client observed with steady gait upon ambulation
## Footnote
The observation of a steady gait while ambulating indicates the relief of pain associated with osteoarthritis.
47
A nurse is caring for a client who is taking naproxen following an exacerbation of rheumatoid arthritis. Which of the following statements by the client requires further discussion by the nurse?
A. "I signed up for a swimming class."
B. "I've been taking an antacid to help with indigestion."
C. "I've lost 2 pounds since my appointment 2 weeks ago."
D. "The naproxen is easier to take when I crush it and put it in applesauce."
B. "I've been taking an antacid to help with indigestion."
## Footnote
NSAIDs, like naproxen, can cause serious adverse gastrointestinal reactions such as ulceration, bleeding, and perforation. Warning manifestations such as nausea or vomiting, gastrointestinal burning, and blood in the stool reported by the client require further investigation by the nurse. The client might be taking an antacid because he is experiencing one or more of these manifestations.
48
A client who is receiving medication for an eye disorder reports bleeding in the eye. Which medication will the nurse expect to find in the client’s recent medication history?
A. Ketorolac
B. Trifluridine
C. Natamycin
D. Ciprofloxacin
A. Ketorolac
## Footnote
Ketorolac is a nonsteroidal anti-inflammatory medication that may disrupt platelet aggregation and can lead to bleeding in the eyes.
49
An adult client has prescriptions for morphine sulfate 2.5 mg IV every 6 hours and ketorolac (Toradol) 30 mg IV every 6 hours. Which action should the nurse implement?
A. Administer both medications according to the prescription.
B. Hold the ketorolac to prevent an antagonistic effect.
C. Hold the morphine to prevent an additive drug interaction.
D. Contact the healthcare provider to clarify the prescription.
A. Administer both medications according to the prescription.
## Footnote
Morphine and ketorolac (Toradol) can be administered concurrently, and may produce an additive analgesic effect, resulting in the ability to reduce the dose of morphine, as seen in this prescription.
50
A client is starting celecoxib to treat osteoarthritis. The nurse should instruct the client to watch for and report which of the following adverse effects?
A. Black, tarry stools
B. Bone pain
C. Dry mouth
D. Polyuria
A. Black, tarry stools
## Footnote
Celecoxib can cause gastrointestinal bleeding. The client should watch for and report black, dark-colored, or bloody stools, abdominal pain, or coffee-ground emesis.
51
A client with osteoarthritis receives a new prescription for celecoxib (Celebrex) orally for symptom management. The nurse notes the client is allergic to sulfa. Which action is most important for the nurse to implement prior to administering the first dose?
A. Review the client's hemoglobin results.
B. Notify the healthcare provider.
C. Inquire about the reaction to sulfa.
D. Record the client's vital signs.
B. Notify the healthcare provider
## Footnote
Celebrex contains a sulfur molecule, which can lead to an allergic reaction in individuals who are sensitive to sulfonamides, so the healthcare provider should be notified of the client's allergies
52
A nurse is caring for a client who is using a patient-controlled analgesia (PCA) pump for postoperative pain management. The nurse enters the room to find the client asleep and his partner pressing the button to dispense another dose. Which of the following responses should the nurse make?
A. "Next time you think he needs more medication, call me and I’ll push the button."
B. "It’s a good idea to help make sure your husband can sleep comfortably."
C. "Why do you think your husband needs more medication when he is asleep?"
D. "Your husband should decide when more medication is needed."
D. "Your husband should decide when more medication is needed."
## Footnote
The nurse should explain to the client’s partner that the client is the only one who should operate the PCA pump.
53
The nurse is educating a client about the use of fentanyl citrate via a patient-controlled analgesia pump. Which of the following statements should be included in the teaching?
A. You cannot breastfeed your baby while using a patient controlled analgesia pump
B. You may get drowsy if you press the administration button too many times
C. The administration button should not be pressed by anyone other than you
D. A patient controlled analgesia pump reduces the risk of post-partum hemorrhage
C. The administration button should not be pressed by anyone other than you
## Footnote
The client is the only person who should press the administration button.
54
The nurse is teaching the client about the patient-controlled analgesia (PCA) planned for postoperative care. Which statement by the client indicates further teaching is needed?
A. "I will receive a continuous dose of medication."
B. "I need to call the nurse before I take additional doses."
C. "The machine will prevent an overdose of the medication."
D. "I will call for assistance if my pain is not relieved."
B. "I need to call the nurse before I take additional doses."
55
After surgery, an adolescent has a patient-controlled analgesia (PCA) pump that is set to allow morphine delivery every 6 minutes. Which statement indicates to the nurse that the family understand instructions about the PCA pump?
A. 'I’ll make sure that she pushes the PCA button every 6 minutes.'
B. 'She needs to push the PCA button whenever she needs pain medication.'
C. 'I’ll have to wake her up on a regular basis so she can push the PCA button.'
D. 'I’ll press the PCA button every 6 minutes so she gets enough pain medication while she’s sleeping.'
B. 'She needs to push the PCA button whenever she needs pain medication.'
## Footnote
only the adolescent should press the PCA button. Having the adolescent press the PCA button every 6 minutes is unnecessary. If the adolescent is sleeping, the pain is under control
56
A nurse is preparing to discontinue a client’s fentanyl patient-controlled analgesia infusion. Which priority action will the nurse take before discontinuing the infusion?
A. Assess the client pain level
B. Document the frequency of doses on the medication administration record
C. Take the client vital signs
D. Verify the infusion record with another registered nurse
D. Verify the infusion record with another registered nurse
## Footnote
The nurse should verify the infusion record with another licensed healthcare provider before discontinuation. Fentanyl is a controlled substance that requires recordkeeping of its usage.
57
A charge nurse is supervising a newly licensed nurse provide care for a client who has a PCA pump. Which of the following statements made by the nurse requires further action by the charge nurse?
A. "I discarded the remaining 2 milligrams of morphine from the PCA pump. Please document that you witnessed it, even though you didn’t."
B. "I noted that my client pushed the PCA button six times in the last hour, and the PCA lockout is set for 10 minutes."
C. "I gave my client a bolus dose of morphine when I initiated the PCA pump."
D. "I told the client’s family that they must not push the PCA button for the client."
A. "I discarded the remaining 2 milligrams of morphine from the PCA pump. Please document that you witnessed it, even though you didn’t."
## Footnote
Two nurses are required to witness the wasting of a narcotic and then sign the narcotic record. The nurse should not ask another nurse to sign the narcotic record if the nurse did not witness wasting the narcotic.
58
A client is prescribed morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per patient-controlled analgesia (PCA) pump for a total of 5 mg IV maximally per hour. Which nursing action has the highest priority before initiating the PCA pump?
A. Assessment of the expiration date on the morphine syringe in the pump.
B. Assessment of the rate and depth of the client's respirations.
C. Assessment of the type of anesthesia used during the surgical procedure.
D. Assessment of the client's subjective and objective signs of pain.
B. Assessment of the rate and depth of the client's respirations.
## Footnote
A life-threatening side effect of intravenous administration of morphine sulfate is respiratory depression. Prior to the initiation of the patient-controlled analgesia (PCA) pump, the nurse should assess the client's respirations to obtain a baseline of the client's respiratory rate and depth.
59
Which rationale would the nurse give to explain the purpose of administering an opioid analgesic via epidural catheter when providing postoperative teaching?
A. Facilitates oxygen use
B. Relieves abdominal pain
C. Decreases anxiety and restlessness
D. Dilates coronary and peripheral blood vessels
B. Relieves abdominal pain
## Footnote
Although decreasing anxiety and restlessness may be responses to an opioid, they are not the primary reason why opioids are used after abdominal surgery.
60
The nurse on a surgery unit is evaluating which client would be appropriate for patient-controlled analgesia (PCA). Which client would not be appropriate for PCA?
A. A 25-year-old client with a history of Down syndrome.
B. A 16-year-old client who reads at a fourth-grade level.
C. A 71-year-old client with numerous arthritic nodules on their hands.
D. A 4-year-old client with intermittent episodes of alertness.
D. A 4-year-old client with intermittent episodes of alertness.
## Footnote
The 4-year-old client (preschool-aged) is most likely to have difficulty with the use or understanding of a patient-controlled analgesia (PCA) pump.
61
A nurse is teaching a client about how to use a patient-controlled analgesia (PCA) pump. Which of the following instructions should the nurse include in the teaching?
A. "Use the pain scale to determine if you need to self-administer."
B. "Ask a family member to push the patient-control button when the client is sleeping."
C. "There is a 30 minute lock-out limit programmed on your PCA pump."
D. "Several bolus doses are infused if the button is pushed repeatedly within a 5 to 10 minute timeframe before lock-out."
A. "Use the pain scale to determine if you need to self-administer."
## Footnote
The nurse should instruct the client to use the pain scale to rate his pain level before self-administering a bolus dose.
62
A nurse is teaching a client who had a total knee arthroplasty about self-administering morphine via a patient-controlled analgesia (PCA) infusion device. Which of the following client statements indicates an understanding of the teaching?
A. "I should only use the device when it’s absolutely necessary."
B. "I will ask my family to push the dose button when I am asleep."
C. "I’ll be careful about pushing the button so I don’t overdose."
D. "I should tell the nurse if I can’t control my pain with this device."
D. "I should tell the nurse if I can’t control my pain with this device."
## Footnote
The client should notify the nurse if pain control is not achieved. The nurse can initiate a re-evaluation of the client’s pain management plan.
63
A client receives intrathecal morphine to control severe postoperative pain. Which action will the nurse include as part of the client’s initial 24-hour postoperative care plan?
A. Monitoring of respiratory rate hourly
B. Assessing the client for tachycardia
C. Administering naloxone every 3 to 4 hours
D. Observing the client for signs of central nervous system (CNS) excitement
A. Monitoring of respiratory rate hourly
## Footnote
Intrathecal morphine can depress respiratory function depending on the level it reaches within the spinal column; hourly assessments during the first 12 to 24 hours will allow for early intervention with an antidote if respiratory depression needs to be corrected.
64
A nurse is caring for a client who is postoperative following abdominal surgery and reports incisional pain. The surgeon has prescribed morphine 4 mg IV bolus every 6 hr as needed. Before administering this medication, the nurse should complete which priority assessment?
A. Blood pressure
B. Apical heart rate
C. Respiratory rate
D. Temperature
C. Respiratory rate
## Footnote
The priority action the nurse should take when using the airway, breathing, and circulation (ABC) approach to client care is to evaluate the client's respirations.
65
A nurse is caring for a client who is postoperative following abdominal surgery and reports incisional pain. The surgeon has prescribed morphine 4 mg IV bolus every 6 hr as needed. Before administering this medication, the nurse should complete which priority assessment?
A. Blood pressure
B. Apical heart rate
C. Respiratory rate
D. Temperature
C. Respiratory rate
## Footnote
The priority action the nurse should take when using the airway, breathing, and circulation (ABC) approach to client care is to evaluate the client's respirations. The respiratory rate is especially important because opioid analgesics like morphine can cause respiratory depression.
66
A nurse is preparing to administer morphine to a client with chronic pain. Which assessment finding would prompt the nurse to withhold the medication?
A. Heart rate of 117 beats/min
B. Urine output of 35 ml/hr
C. Oxygen saturation of 92%
D. Respiratory rate of 11 breaths/min
D. Respiratory rate of 11 breaths/min
## Footnote
The nurse should withhold the medication if the respiratory rate is 11 breaths/min.
67
The nurse is teaching a client who is postoperative cesarean section about prescribing morphine via a patient-controlled device. Which statement should the nurse include in client teaching about the medication?
A. It is normal for this medication to cause burning at the IV site
B. You will probably experience some itching each time you administer a dose
C. Tell your family members to press the administration button if you are feeling tired
D. Let a staff member know if you experience any trouble breathing
D. Let a staff member know if you experience any trouble breathing
## Footnote
Opioids can cause respiratory depression. When teaching about the patient-controlled device, the nurse should instruct the client to report any changes in respiratory status, including shortness of breath.
68
Which adverse effect of morphine indicates the need for naloxone administration?
A. Blurred vision
B. Urinary retention
C. Mental confusion
D. Respiratory depression
D. Respiratory depression
## Footnote
Because morphine is a central nervous system depressant, it affects the medulla, the respiratory center in the brain. Respiratory depression may progress to respiratory arrest and death.
69
A client takes morphine sulfate for severe metastatic bone pain. The nurse will assess the client for which adverse effect?
A. Diarrhea
B. Addiction
C. Respiratory depression
D. Diuresis
C. Respiratory depression
## Footnote
Morphine sulfate is a central nervous system depressant that commonly decreases the respiratory rate, which can lead to respiratory arrest.
70
The nurse is caring for a client with acute pain and realizes a medication error has occurred. The client received twice the ordered dose of morphine an hour ago. Which nursing problem is the priority at this time?
A. Chronic pain
B. Respiratory depression
C. Constipation
D. Tolerance
B. Respiratory depression
## Footnote
Respiratory depression is a life-threatening risk in an opioid overdose
71
Which client should the nurse identify as being at highest risk for complications during the use of an opioid analgesic?
A. An older client with Type 2 diabetes mellitus.
B. A client with chronic rheumatoid arthritis.
C. A client with a open compound fracture.
D. A young adult with inflammatory bowel disease.
D. A young adult with inflammatory bowel disease.
## Footnote
The principal indication for opioid use is acute pain, and a client with inflammatory bowel disease is at risk for toxic megacolon or paralytic ileus related to slowed peristalsis, a side effect of morphine.
72
A client who has been diagnosed with a myocardial infarction receives digoxin, fluoxetine, morphine, and docusate sodium. Which medication would the nurse identify as a risk factor for straining due to constipation?
A. Digoxin
B. Morphine
C. Docusate
D. Fluoxetine
B. Morphine
## Footnote
Opioids decrease peristalsis, which may precipitate constipation; straining at stool should be avoided to prevent the Valsalva maneuver, which increases demands on the heart.
73
A nurse is reviewing the medication administration records of four clients who have a prescription for morphine PRN. Which of the following findings should the nurse identify as a contraindication to this medication?
A. The client is experiencing a myocardial infarction.
B. The client who is 24 hr postoperative following hip arthroplasty.
C. The client who has bronchitis pleurisy.
D. The client has a paralytic ileus (frozen intestines).
D. The client has a paralytic ileus (frozen intestines).
## Footnote
Morphine is contraindicated in clients who have a paralytic ileus because morphine suppresses the propulsive contractions of the intestinal tract and inhibits secretion of fluids into the intestinal tract.
74
The nurse is preparing an education session for a client prescribed opioids for intractable cancer pain. The nurse should include strategies to help prevent which common side effect associated with long-term use of opioids?
A. Sedation.
B. Constipation.
C. Urinary retention.
D. Respiratory depression.
B. Constipation.
## Footnote
The client should be prepared to implement measures for constipation, which is the most likely persistent side effect related to opioid use.
75
The nurse is assessing a client who is taking prescribed opioids for pain. Which finding should indicate to the nurse that the client is having a side effect of the medication?
A. Decreased skin turgor
B. No bowel movement for four days
C. Hypertension
D. Increased respiratory effort
B. No bowel movement for four days
## Footnote
Opioids slow down processes in the body, including gastrointestinal motility, so a possible side effect of this medication would be constipation
76
A hospice nurse is caring for a client who has terminal cancer and takes PO morphine for pain relief. The client reports that he had to increase the dose of morphine this week to obtain pain relief. Which of the following scenarios should the nurse document as the explanation for this situation?
A. The client not been taking the medication properly.
B. The client is experiencing episodes of confusion.
C. The client has become addicted to the medication.
D. The client developed a tolerance to the medication.
D. The client developed a tolerance to the medication.
## Footnote
Tolerance is an adverse effect of narcotic analgesics in which a larger dose is needed to produce the same response.
77
A client with a known history of opioid addiction has a surgical repair of multiple stab wounds to the abdomen. After surgery, the client’s pain is not relieved by the prescribed morphine injections. Which phenomenon is the client experiencing when they fail to achieve pain relief?
A. Tolerance
B. Habituation
C. Physical addiction
D. Psychological dependence
A. Tolerance
## Footnote
Tolerance is a phenomenon that occurs in addicted individuals. It means that increasing amounts of the drug of addiction are required to satisfy need.
78
A terminally ill client is receiving a morphine drip that exceeds the typical recommended dosage. The client’s spouse tells the nurse that the client is again uncomfortable and needs the morphine increased. The prescription states to titrate the morphine to comfort level. Which action will the nurse take?
A. Add a placebo to the morphine to appease the spouse.
B. Discuss with the spouse the risk for morphine addiction.
C. Assess the client’s pain before increasing the dose of morphine.
D. Check the client’s heart rate before increasing the morphine to the next level.
C. Assess the client’s pain before increasing the dose of morphine.
## Footnote
Over time clients receiving morphine develop tolerance and require increasing doses to relieve pain, thus requiring continuing pain reassessments to ensure that the client does not have signs of toxicity such as respiratory depression.
79
A client who had a myocardial infarction receives 15 mg of morphine sulfate for chest pain. Fifteen minutes after receiving the medication, the client complains of feeling dizzy. Which action will the nurse take?
A. Determine if this is an allergic reaction.
B. Elevate the client’s head and keep the extremities warm.
C. Place the client in the supine position and take the vital signs.
D. Tell the client that this is not a typical sensation after receiving morphine sulfate.
C. Place the client in the supine position and take the vital signs.
## Footnote
Dizziness is a symptom of hypotension, a side effect of morphine sulfate. The supine position increases venous return, cardiac output, and blood flow to the brain.
80
After surgery the client has a prescription for morphine sulfate via intravenous (IV) route every 3 hours as needed for pain. The client’s preoperative blood pressure was 128/76 mm Hg. Postoperative assessments reveal that the client’s blood pressure ranges between 80/60 mm Hg and 100/70 mm Hg. Which action will the nurse take if the client requests medication for pain?
A. Administer morphine as prescribed.
B. Obtain a prescription for a vasoconstrictor.
C. Give half the prescribed amount of morphine.
D. Withhold morphine until the blood pressure stabilizes.
D. Withhold morphine until the blood pressure stabilizes.
## Footnote
Morphine is an opioid analgesic that may decrease the blood pressure further. It should be withheld and not administered at this time.
81
Which response to morphine would need to be reported immediately to the health care provider?
A. Nausea
B. Headache
C. Drowsiness
D. Bradycardia
D. Bradycardia
## Footnote
Because morphine is a central nervous system depressant, it may cause bradycardia, shock, and cardiac arrest.
82
A client, admitted to the cardiac care unit with a myocardial infarction, complains of chest pain. Which intervention will be most effective in relieving the client’s pain?
A. Nitroglycerin sublingually
B. Oxygen per nasal cannula
C. Lidocaine hydrochloride 50-mg intravenous (IV) bolus
D. Morphine sulfate 2 mg IV
D. Morphine sulfate 2 mg IV
## Footnote
Morphine decreases systemic vascular resistance, which decreases left ventricular afterload, thus decreasing myocardial oxygen consumption.
83
The nurse is caring for a client hospitalized with a myocardial infarction. Which analgesic is the medication of choice for this client?
A. Ketorolac
B. Meperidine
C. Flurazepam
D. Morphine sulfate
D. Morphine sulfate
## Footnote
For myocardial infarction, morphine sulfate is the medication of choice because it relieves pain quickly and reduces anxiety while decreasing cardiac workload.
84
A client with a myocardial infarction is admitted to the cardiac intensive care unit. Which pain relief medication would the nurse expect to find on the plan of care for this client?
A. Morphine
B. Diazepam
C. Midazolam
D. Oxycodone
A. Morphine
85
A client in the coronary care unit develops 'viselike' chest pain radiating to the neck. Assessment reveals a blood pressure of 124/64 mm Hg, an irregular apical pulse of 64 beats per minute, and diaphoresis. Cardiac monitoring is instituted, and morphine sulfate 4 mg intravenous (IV) push stat is prescribed. Which intervention is the priority nursing care for this client?
A. Relief of pain
B. Client teaching
C. Cardiac monitoring
D. Maintenance of bed rest
A. Relief of pain
## Footnote
Unrelieved chest pain increases anxiety, fatigue, and myocardial oxygen consumption, with the possibility of extending the infarction.
86
A health care provider prescribes morphine for a client being treated for myocardial infarction. Which physiological response will occur if the client experiences the intended therapeutic effect of morphine?
A. Increased respiratory rate
B. Decreased workload of the heart
C. Dilation of coronary arteries
D. Diminished metabolites within the ischemic heart muscle
B. Decreased workload of the heart
## Footnote
Morphine reduces pain and anxiety. This limits the response of the sympathetic nervous system, ultimately decreasing cardiac preload and the workload of the heart.
87
Morphine has been prescribed for a client in a hospice home care program. Which information will the nurse provide regarding this pain management regimen?
A. Medication addiction is a concern with this medication.
B. Request the medication before the pain becomes severe.
C. Dosages of the medication will be given automatically at regular intervals around the clock.
D. Intermittent administration of the medication is possible after an intermittent lock is inserted.
C. Dosages of the medication will be given automatically at regular intervals around the clock.
## Footnote
The medication will be given routinely to maintain a continuous therapeutic blood level to keep the terminally ill client comfortable.
88
The nurse is caring for an 81-year-old client with colorectal cancer. Previously, the client's pain was managed with acetaminophen with codeine. However, the client is now experiencing frequent, severe pain and intravenous morphine has been prescribed. What should the nurse recognize about this order?
A. Inappropriate due to the potential of respiratory depression
B. Inappropriate and demonstrates lack of knowledge related to pain control
C. Appropriate despite the risk of diarrhea and abdominal upset
D. Appropriate pain management and should be available around the clock
D. Appropriate pain management and should be available around the clock
## Footnote
Older adults with cancer pain are frequently undermedicated. Pain management with IV morphine, while risky, is appropriate with proper assessment and monitoring of the client.
89
The nurse is caring for a client who is actively dying and has been receiving high doses of opioid analgesics. The client has become unresponsive to verbal stimuli. What action should the nurse take?
A. Stop giving the analgesic
B. Give an extra dose of the analgesic
C. Decrease the analgesic dosage by half
D. Continue the analgesic at the current dose
D. Continue the analgesic at the current dose
## Footnote
Clients who are actively dying and have been experiencing chronic pain, will probably continue to experience pain even though they cannot communicate this.
90
A hospice client who has severe pain asks for another dose of oxycodone/morphine/opioid. Which consideration is the nurse’s primary concern when responding to the client’s request?
A. Prevent addiction.
B. Determine why the medication is needed.
C. Provide alternative comfort measures.
D. Reduce the client’s pain.
D. Reduce the client’s pain.
## Footnote
Hospice clients with severe pain need increasing levels of analgesics and should be maintained at a pain-free level, even if addiction occurs. Pain management, not the prevention of addiction, is the priority.
91
An adolescent client has orders for morphine sulfate for severe pain and acetaminophen-codeine compound for moderate pain after a spinal fusion. The pain assessment reveals the client is rigid and crying in pain. Which information would influence the nurse’s choice of analgesic?
A. One dose of morphine may be given, but the drug should be restricted thereafter because it is addictive.
B. Adolescents tend to exaggerate their discomfort, particularly when they are immobilized by surgery or injury.
C. Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic.
D. The acetaminophen-codeine compound is preferred because morphine can cause respiratory depression or respiratory arrest.
C. Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic.
## Footnote
Spinal fusion causes considerable pain for several days and requires a strong analgesic.
92
Which medication would the nurse anticipate will be prescribed to relieve anxiety and apprehension in a client with pulmonary edema?
A. Morphine
B. Phenobarbital
C. Hydroxyzine
D. Chloral hydrate
A. Morphine
## Footnote
Morphine binds with the same receptors as natural opioids. However, it has a rapid onset, lowers the blood pressure, decreases pulmonary reflexes, and produces sedation.
93
Which medications should the nurse caution the client about taking while receiving an opioid analgesic?
A. Antacids.
B. Benzodiazepines.
C. Antihypertensives.
D. Oral antidiabetics.
B. Benzodiazepines.
## Footnote
Respiratory depression increases with the concurrent use of opioid analgesics and other central nervous system depressant agents, such as alcohol, barbiturates, and benzodiazepines
94
Which member of the health care team would the nurse ask to serve as a witness when wasting unused morphine?
A. Nursing supervisor
B. Licensed practical nurse (LPN) or RN
C. Client’s health care provider
D. Designated nursing assistant
B. Licensed practical nurse (LPN) or RN
## Footnote
The wasting of controlled substances should be witnessed by two licensed personnel according to federal regulations; this can be done by a registered nurse (RN) or LPN.
95
A staff nurse is assisting a charge nurse with checking controlled substances at the change of shift. The charge nurse is urgently called to a client’s room and has to leave the medication room. Which action will the staff nurse take?
A. Continue performing the check while the charge nurse assists the client
B. Leave the medication room to find another nurse to assist with the check
C. Stop the check and sign out of the medication dispensing system
D. Pause the check until the charge nurse returns to the medication room
C. Stop the check and sign out of the medication dispensing system
## Footnote
Performing inventory on controlled substances with another nurse should be finalized in one session. If one of the nurses is unable to complete the count, the session should be terminated, and the dispensing system should be secured.
96
At which time would the nurse plan to administer morphine 2 mg by mouth every 2 hours as needed to a client who has burns on 55% of the body surface and requires dressing changes?
A. 15 minutes before the dressing change
B. 60 minutes before the dressing change
C. Along with a stool softener each time it is administered
D. Only if the client rates pain between 8 and 10 on the pain scale
B. 60 minutes before the dressing change
## Footnote
Oral morphine takes 30 to 90 minutes to reach peak effect and can be administered at least 60 minutes before the dressing change.
97
The nurse is providing care for a client after surgery. The client has an order for acetaminophen with codeine. The client asks the nurse what to expect after taking this medication. Which is the best response by the nurse?
A. "This combination medication will better help to manage your pain."
B. "The combination medication will reduce the chance of addiction."
C. "This medication will minimize any side effects from the codeine."
D. "This medication combination will allow healing to occur faster."
A. "This combination medication will better help to manage your pain."
## Footnote
The use of acetaminophen with codeine potentiates the effect of the codeine, thus providing greater/better pain relief.
98
A postoperative client has a prescription for acetaminophen with codeine for pain relief. The nurse understands which action to be the primary purpose of this drug combination?
A. Enhanced pain relief
B. Faster onset of action
C. Prevents tolerance
D. Minimized side effects
A. Enhanced pain relief
## Footnote
Because codeine and non-opioid analgesics relieve pain by different mechanisms, the combinations can produce greater (enhanced) pain relief than either agent alone.
99
A nurse is evaluating a client who was prescribed 30 mg of codeine after oral surgery. Which assessment finding indicates the expected outcome of the medication?
A. Normoactive bowel sounds
B. Absence of pain
C. Decreased cough reflex
D. Normal respiratory rate
B. Absence of pain
## Footnote
The expected outcome of codeine taken after oral surgery is the absence of pain.
100
A client recovering from hip replacement surgery is taking acetaminophen with codeine every three hours for pain. For which side effect should the nurse monitor the client?
A. Constipation
B. Wheezing
C. Diffuse rash
D. Hyperglycemia
A. Constipation
## Footnote
Opioids such as codeine slow down the function of the central nervous system. This can affect involuntary movements in the body, such as peristalsis.
101
A nurse is teaching a client who has a new prescription for codeine. Which of the following instructions should the nurse include in the teaching?
A. 'You should take the medication on an empty stomach to prevent nausea."
B. "You should limit alcohol intake to 12 ounces daily."
C. "You should expect to experience diarrhea while taking this medication."
D. "You should change positions slowly."
D. "You should change positions slowly."
## Footnote
The client should change positions slowly to avoid the risk of falls.
102
A nurse is preparing to administer a hydromorphone injection to a client. As the nurse begins to connect the syringe to the intravenous port, the client refuses the medication. Which action does the nurse perform next?
A. Discard the medication in the presence of another nurse
B. Dispose of the syringe in the sharps container
C. Flush the unused medication in the sink
D. Document the client refusal of the medication in the electronic record
A. Discard the medication in the presence of another nurse
## Footnote
Hydromorphone is a controlled substance that is regulated by federal law. Any unused medication should be discarded in the presence of another licensed provider
103
A client received hydromorphone orally one hour ago. When the nurse enters the client's room, the client is unresponsive to verbal stimuli and has a respiratory rate of six breaths per minute. Which action should the nurse take next?
A. Begin cardiopulmonary resuscitation.
B. Prepare to administer naloxone.
C. Administer supplemental oxygen.
D. Prepare for endotracheal intubation
B. Prepare to administer naloxone.
## Footnote
Hydromorphone is an opioid analgesic. The client seems to be experiencing central nervous system and respiratory depression related to the medication. The antidote for opioids is naloxone.
104
A nurse is caring for a newborn who has respiratory depression secondary to opioids. Which of the following medications should the nurse anticipate administering?
A. Flumazenil
B. Physostigmine
C. Terbutaline
D. Naloxone
D. Naloxone
## Footnote
Naloxone is an opioid antagonist and is administered to reverse opioid toxicity or reverse neonatal respiratory depression.
105
A nurse is preparing to administer morphine IV to a client. Which of the following medications should the nurse plan to have available in case of overdose?
A. Flumazenil
B. Naloxone
C. Protamine
D. Neostigmine
B. Naloxone
## Footnote
Naloxone is given to reverse the effects of morphine. Then nurse should monitor the client for respiratory depression, bradycardia, and hypotension.
106
A nurse is caring for a newborn who has respiratory depression secondary to opioids. Which of the following medications should the nurse anticipate administering?
A. Flumazenil
B. Physostigmine
C. Terbutaline
D. Naloxone
D. Naloxone
## Footnote
Naloxone is an opioid antagonist and is administered to reverse opioid toxicity or reverse neonatal respiratory depression.
107
Which relationship reflects the relationship of naloxone to morphine sulfate?
A. Aspirin to warfarin
B. Amoxicillin to infection
C. Enoxaparin to dalteparin
D. Protamine sulfate (antidote for overdosing on heparin) to heparin
D. Protamine sulfate (antidote for overdosing on heparin) to heparin
## Footnote
Protamine sulfate is the antidote for heparin overdose, and naloxone will reverse the effects of opioids such as morphine.
108
A client who receives morphine by patient-controlled analgesia has a respiratory rate of 6 breaths/minute. Which intervention is needed?
A. Nasotracheal suction
B. Mechanical ventilation
C. Naloxone administration
D. Cardiopulmonary resuscitation
C. Naloxone administration
## Footnote
Naloxone is an opioid antagonist and will reverse respiratory depression caused by opioids.
109
Which medication is indicated for management of clinical manifestations associated with an opioid overdose?
A. Naloxone
B. Methadone
C. Epinephrine
D. Amphetamine
A. Naloxone
## Footnote
Naloxone is a narcotic antagonist that displaces opioids from receptors in the brain, thereby reversing respiratory depression.
110
Naloxone effectively reverses a client’s respiratory depression from an overdose of heroin. Which rationale explains why the nurse will continue to closely monitor this client’s status?
A. Naloxone and herioin can cause cardiac depression when combined.
B. The medication may cause peripheral neuropathy.
C. Symptoms of the heroin overdose may return after the naloxone is metabolized.
D. Hyperexcitability and amnesia may cause the client to thrash about and become injured.
C. Symptoms of the heroin overdose may return after the naloxone is metabolized.
## Footnote
The duration of action of naloxone is shorter than that of heroin. After naloxone is metabolized and its effects are diminished, the respiratory distress caused by the heroin overdose will return, necessitating readministration of naloxone.
111
Which mechanism of action explains why naloxone is administered for a heroin overdose?
A. Competition with opioids for occupancy of opioid receptors
B. Blunts severity of withdrawal symptoms as heroin wears off
C. Accelerated metabolism of heroin and stimulation of respiratory centers
D. Stimulation of cortical sites that control consciousness and cardiovascular
A. Competition with opioids for occupancy of opioid receptors
## Footnote
Naloxone is used to treat opioid-induced apnea. It competes with the opioid for central nervous system receptor sites and thus acts as an opioid antagonist.
112
The healthcare provider prescribes naloxone (Narcan) for a client in the emergency room. Which assessment data would indicate that the naloxone has been effective?
A. A client's statement that the chest pain is better.
B. Respiratory rate is 16 breaths/minute.
C. Seizure activity has stopped temporarily.
D. Pupils are constricted bilaterally.
B. Respiratory rate is 16 breaths/minute.
## Footnote
Naloxone (Narcan) is a narcotic antagonist that reverses the respiratory depression effects of opiate overdose, so assessment of a normal respiratory rate would indicate that the respiratory depression has been reversed.
113
The health care provider writes a new order for a fentanyl patch to manage chronic pain experienced by a client in hospice care. The nurse is teaching the client and family members about the fentanyl patch. What is the ONLY **incorrect** response?
A. "I can soak in a hot tub to help decrease my pain with my fentanyl patch."
B. "It may take up to a half day or longer for the patch to start working, the first time I use it."
C. "If my pain is too great while I am on the patch, I can take a supplemental pain medication."
D. "I will take the old patch off before I apply the new patch on a different part of my body."
A. "I can soak in a hot tub to help decrease my pain with my fentanyl patch."
## Footnote
The client can shower or bathe with the patch, but it should not be exposed to heat (hot tubs, heating pads) because it speeds up the absorption of the medication.
114
A health care provider prescribes transdermal fentanyl 25 mcg/h every 72 hours. During the first 24 hours after starting the fentanyl, the nurse recognizes the need to take which action?
A. Titrate the dose until pain is tolerable.
B. Manage pain with an analgesic by a different route.
C. Assess the client for anticholinergic side effects.
D. Instruct the client to take the medication with food.
B. Manage pain with an analgesic by a different route.
## Footnote
It takes 24 hours to reach the peak effect of transdermal fentanyl. An alternate-route pain medication may be necessary to support client comfort until the fentanyl reaches its peak effect.
115
A client using fentanyl transdermal patches for pain management in late-stage cancer dies. Which action will the hospice nurse take regarding the patch in use at the time of death?
A. Tell the family to remove and dispose of the patch.
B. Leave the patch in place for the mortician to remove.
C. Have the family return the patch to the pharmacy for disposal.
D. Remove and dispose of the patch in an appropriate receptacle.
D. Remove and dispose of the patch in an appropriate receptacle.
## Footnote
The nurse would remove and dispose of the patch in a manner that protects self and others from exposure to the fentanyl. This involves folding the patch so that adhesive edges are together. The nurse would flush the patch down the toilet or place it in a proper disposal receptacle following the local governmental policy.
116
A nurse is reviewing analgesic prescriptions for a client with a history of liver cirrhosis. The prescriptions state to administer PRN for pain. Which medication is the nurse most likely to administer to this client?
A. Fentanyl
B. Acetaminophen
C. Ibuprofen
D. Ketorolac
A. Fentanyl
## Footnote
The nurse is most likely to administer fentanyl to a client with liver disease. Fentanyl is an opioid analgesic with a short duration.
117
A nurse has removed a 2 ml vial of fentanyl from the medication dispensing system. After dosage calculations, the nurse determines only 1 ml will be administered to the client. Which action will the nurse perform with the remainder of the medication?
A. Request another nurse to witness wasting of the unused medication
B. Dispose of the unused medication in the sink
C. Store the unused of the medication in the medication cart
D. Return the unused medication to the dispensing system
A. Request another nurse to witness wasting of the unused medication
## Footnote
Unused controlled substances such as fentanyl should be wasted. The waste of narcotics requires a witness. The nurse should request another licensed nurse to witness the waste of the additional 1 ml of medication.
118
A school-age child with end-stage cancer has a continuous infusion of morphine to manage their pain. Breakthrough pain occurs and a fentanyl 'lollipop' is prescribed. Which instruction would the nurse give the child regarding the use of the lollipop when pain occurs?
A. 'Chew it and then swallow every 4 hours.'
B. 'Suck on it for half an hour every 6 hours.'
C. 'Hold it in your cheek only until the pain is relieved.'
D. 'Place it in your mouth and suck on it until it dissolves.'
C. 'Hold it in your cheek only until the pain is relieved.'
## Footnote
The fentanyl lozenge is absorbed through the buccal mucosa; once the pain is relieved the lozenge should be removed and kept until it is needed again.
119
The nurse understands which anesthetic medication is commonly used for short procedures on pediatric clients?
A. Fentanyl
B. Morphine
C. Meperidine
D. Hydromorphone
A. Fentanyl
## Footnote
Fentanyl is recommended for short procedures on pediatric clients.
120
A client with a history of osteoporosis and vertebral compression has been coming to the clinic more frequently for prescription refills of hydrocodone/acetaminophen. Which inference will the nurse make?
A. The half-life of the medication has decreased.
B. An idiosyncratic reaction has occurred.
C. Higher doses are needed to achieve pain relief.
D. An emotional dependence on the medication has developed.
C. Higher doses are needed to achieve pain relief.
## Footnote
As the body adapts to the medication (tolerance), an increased dose is needed to produce the desired effect.
121
In which time frame would the nurse advise a client with a long leg cast for a fractured bone to take the prescribed as-needed oxycodone?
A. Just as a last resort
B. Before going to sleep
C. As the pain becomes intense
D. When the discomfort begins
D. When the discomfort begins
## Footnote
Pain is most effectively relieved when an analgesic is administered at the onset of pain, before it becomes intense; this prevents a pain cycle from occurring.
122
A client takes oxycodone every 3 hours for pain after surgery. Which actions below would the nurse NOT take before administering each dose of oxycodone?
A. Count the client’s respiratory rate.
B. Observe the client for movement disorders.
C. Ask the client to rate the level of pain.
D. Assess the client’s level of consciousness.
B. Observe the client for movement disorders.
## Footnote
Petechiae (or other signs of bleeding) and movement disorders are not associated with opioid use.
123
A client is prescribed controlled-release oxycodone. Which dosing schedule is best for the nurse to teach the client?
A. As needed.
B. Every 12 hours.
C. Every 24 hours.
D. Every 4 to 6 hours.
B. Every 12 hours.
## Footnote
A controlled-release oxycodone provides long-acting analgesia to relieve moderate to severe pain, so a dosing schedule of every 12 hours provides the best around-the-clock pain management.
124
A client who is addicted to opioids undergoes emergency surgery. During the postoperative period, the health care provider decreases the previously prescribed methadone dosage. Which clinical manifestations will the nurse monitor for when assessing this client?
A. Constipation and lack of interest in surroundings
B. Agitation and attempts to escape from the hospital
C. Skin dryness and scratching under the incision dressing
D. Lethargy and refusal to participate in therapeutic exercises
B. Agitation and attempts to escape from the hospital
## Footnote
When the methadone dosage is reduced, a craving for opioids may occur, anxiety will increase, and the client will become agitated and may try to leave the hospital to secure drugs.
125
Which characteristic identifies the reason that methadone is useful in the treatment of opioid addiction?
A. Is a nonaddictive medication
B. Has an effect of longer duration
C. Does not produce a cumulative effect
D. Carries little risk of psychological dependence
B. Has an effect of longer duration
## Footnote
Methadone’s duration of effect is 12 to 24 hours, compared with other opioids, which have a 3- to 6-hour duration of effect.
126
A client who is addicted to heroin has major surgery. Afterward, the client receives methadone. Which purpose does the methadone serve?
A. Allows symptom-free termination of opioid addiction
B. Switches the user from illicit opioid use to use of a legal drug
C. Provides postoperative pain control without causing opioid dependence
D. Counteracts the depressive effects of long-term opioid use on thoracic muscles
B. Switches the user from illicit opioid use to use of a legal drug
## Footnote
Methadone may be dispensed legally; the strength of this medication is controlled and remains constant from dose to dose, unlike illicit drugs.
127
Which medication will the nurse question when it is prescribed for a client with acute pancreatitis?
A. Ranitidine
B. Cimetidine
C. Meperidine
D. Promethazine
C. Meperidine
## Footnote
Meperidine should be avoided because accumulation of its metabolites can cause central nervous system irritability and even tonic-clonic seizures (grand mal seizures).
128
The nurse is providing care for a client diagnosed with sickle cell crisis. Which prescribed medication should the nurse clarify with the health care provider?
A. Morphine
B. Hydromorphone
C. Codeine
D. Meperidine
D. Meperidine
## Footnote
Meperidine, an older opioid analgesic, is not recommended in clients with sickle cell disease. Normeperidine, a metabolite in meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus and generalized seizures when it accumulates in the client's system. Clients with sickle cell disease are at high risk for normeperidine-induced seizures.
129
A nurse is preparing to administer morphine 4 mg IV bolus to a client who reports pain. Available is morphine 10 mg/mL. Which of the following actions should the nurse take with the remaining 6 mg of morphine?
A. Discard the extra medication in a sharps container.
B. Save the extra medication for a later dosing.
C. Send the waste amount to the pharmacy.
D. Have another nurse witness the disposal of the extra medication.
D. Have another nurse witness the disposal of the extra medication.
## Footnote
Any excess narcotic must be disposed. The disposal must be witnessed and documented by a second nurse.
130
A nurse withdraws morphine 2 mg from a 4-mg/mL vial to inject IM for a client. Which of the following actions should the nurse take for wasting the excess medication?
A. Place the excess medication in the sharps container.
B. Save the excess medication for the next administration.
C. Return the excess medication to the secure cabinet.
D. Have a second nurse witness the disposal of the excess medication.
D. Have a second nurse witness the disposal of the excess medication.
## Footnote
Morphine is a controlled substance. Policies vary with the facility, but the nurse must have another nurse witness the disposal of unused portions of doses of controlled substances.
131
Which action would the nurse take when a client refuses to take deep breaths and cough, saying, "It’s too painful," after an abdominal cholecystectomy?
A. Give pain medication regularly as soon as possible.
B. Obtain a prescription to increase the client’s pain medication.
C. Schedule coughing and deep-breathing exercises after analgesic has taken effect.
D. Substitute incentive spirometry for coughing and deep breathing.
C. Schedule coughing and deep-breathing exercises after analgesic has taken effect.
## Footnote
Analgesics limit pain, facilitating effective coughing and deep breathing. Although giving pain medication regularly may be necessary, it must be coordinated with the deep breathing and coughing exercises.
132
A nurse is performing pain assessments on several clients. Which client would benefit the most from the administration of intravenous PRN pain medication?
A. A client eating breakfast verbalizing a headache
B. A client with a fractured arm pending discharge
C. A client post-abdominal surgery sitting comfortably in a chair
D. A client pending bedside debridement of a wound
D. A client pending bedside debridement of a wound
## Footnote
Intravenous pain medication has a rapid onset. A bedside wound debridement is a complex, painful procedure. This client would benefit the most from IV pain medication.
133
A pain scale of 1 to 10 is used by the nurse to assess a client’s degree of pain. The client rates the pain as an 8 before receiving an analgesic and a 7 after being medicated. Which conclusion would the nurse make regarding the client’s response to pain medication?
A. The client has a low pain tolerance.
B. The medication is not adequately effective.
C. The medication has sufficiently decreased the pain level.
D. The client needs more education about the use of the pain scale.
B. The medication is not adequately effective.
## Footnote
The expected effect should be more than a 1-point decrease in the pain level.
134
The nurse is caring for a client with deep partial-thickness burns who is receiving an opioid for pain management. Which mode of medication administration is preferred for this client?
A. Oral
B. Rectal
C. Intravenous
D. Intramuscular
C. Intravenous
## Footnote
The intravenous route provides for the quickest onset of action of the opioid; pain relief occurs almost immediately.
135
The nurse is providing postoperative care for a client who has received a prescription for nalbuphine for pain. Which side effects would the nurse anticipate after administering this medication? Select all that apply. One, some, or all responses may be correct.
A. Nausea
B. Oliguria
C. Sedation
D. Dry mouth
E. Flushed skin
F. Orthostatic hypotension
A. Nausea
C. Sedation
D. Dry mouth
F. Orthostatic hypotension
136
Which treatment would the nurse be referring to when explaining to a client with trigeminal neuralgia that treatment is effective on a temporary (6- to 18-month) basis?
A. Weekly intravenous injections of cobra venom
B. A lidocaine injection at the ventral root of the 11th spinal nerve
C. Microvascular decompression of the blood vessels at the nerve root
D. An alcohol injection at the peripheral branch of the fifth cranial nerve
D. An alcohol injection at the peripheral branch of the fifth cranial nerve
137
The nurse is teaching a client with rheumatoid arthritis about etanercept. Which statement by the client indicates that the client understood the teaching?
A. "I will take the medication daily, first thing in the morning on an empty stomach."
B. "The medication needs to be mixed well. I will shake the bottle to mix it."
C. "I will need to come to the clinic every 6 weeks to receive an intravenous infusion."
D. "I will store the medication in a refrigerator and let it warm to room temperature before injecting it."
D. "I will store the medication in a refrigerator and let it warm to room temperature before injecting it."
138
Etanercept is prescribed for an adolescent with juvenile idiopathic arthritis. Which route would the nurse expect to administer the medication?
A. Sublingual
B. Intravenous
C. Intramuscular
D. Subcutaneous
D. Subcutaneous
139
A nurse is providing teaching to a client who has a new prescription for hydroxychloroquine to treat mild manifestations of rheumatoid arthritis. Which of the following information should the nurse include in the teaching?
A. This medication should be taken between meals.
B. This medication can turn skin an orange color.
C. Wear sunglasses when out in bright sunshine.
D. Avoid crushing the medication.
C. Wear sunglasses when out in bright sunshine.
140
A nurse is preparing to administer indomethacin to a client with acute pain. Which medication on the client’s medical record will prompt the nurse to monitor the client more frequently?
A. Pantoprazole
B. Warfarin
C. Simvastatin
D. Alprazolam
B. Warfarin
141
A nurse is assessing a client who takes prescribed oral indomethacin. Which client statement indicates an intended response to the medication?
A. My appetite is greater in the mornings.
B. I am able to rotate my wrists without pain.
C. I no longer have to urinate in the middle of the night.
D. My endurance while exercising has improved.
B. I am able to rotate my wrists without pain.
