The nurse administers an oral opioid analgesic to a client at 6 PM for pain documented as 6 on a scale of 0 to 10. At 6:30 PM, the client states that the pain level is 3 on a scale of 0 to 10, and that level is acceptable to him. The client asks the nurse
We assess every client in relation to pain, initially to determine appropriate interventions and later to determine whether the interventions were effective in preventing or relieving pain.
Opioid analgesics are used primarily for the treatment of which of the following? Select all that apply:
� Moderate chronic pain
� Mild acute pain
� Severe acute pain
You are caring for a patient who is suffering from postoperative pain. The physician orders 2.5 mg of morphine IV q2h. Morphine is supplied in 10 mg/mL vials. How many mL will you administer in each dose?
0.25 mL
A nurse is caring for a 49-year-old woman in the intensive care unit. The patient was in a motor vehicle accident and is in severe pain. She is being given morphine. After 2 days in the unit, the nurse suspects that the patient is developing a cold. The n
Pneumonia
Sumatriptan
Acute migraine headaches with or without aura. Binds to serotonin to produce vasoconstriction (constriction of blood vessels)
Narcan
Narcotic overdosage; complete or partial reversal of narcotic depression including respiratory depression induced by natural and synthetic narcotics and by pentazocine and propoxyphene. Drug of choice when nature of depressant drug is not known and for di
Which of the following conditions would occur due to the administration of an opioid antagonist in a patient who is physically dependent on opioids?
Withdrawal symptoms
A 50-year-old woman has been prescribed sumatriptan for the treatment of migraines. What instructions should then the nurse provide to the patient about the safe and effective use of this drug?
Take this drug as soon as you feel the first signs of a migraine.
Your client returns from the post anesthesia recovery unit. You note a respiratory rate of 6. Which of the following drugs would you anticipate being given immediately?
Narcan
Morphine has been prescribed for a 28-year-old man with severe pain due to a back injury. The nurse will advise the patient to avoid
Alcohol
A nurse has entered a patient's room at the beginning of a shift in order to quickly assess the patient's airway, breathing, circulation, and consciousness. The nurse observes that the patient is wincing, stating, "I'm having a lot of pain right now." Wha
Where exactly are you having pain right now?" To begin the pain assessment, first determine the location of the pain. Location gives possible clues to the source of the pain and can help identify whether the pain is acute or of a more chronic nature. Que
The A-delta fibers are myelinated and found in the skin and muscle to transmit sharp, well-localized pain signals. True or false?
True. A-delta fibers, which are myelinated and found mainly in the skin and muscle, transmit fast, sharp, well-localized pain signals.
Naloxone (Narcan) will reverse the effects of which of the following drugs?
Fentanyl (Duragesic)
A nurse is caring for a patient with chronic pain who has been prescribed epidural analgesia. The nurse should monitor the patient for which of the following conditions after insertion of the epidural catheter and throughout the therapy?
Respiratory depression. The nurse should closely monitor the patient for respiratory depression after insertion of the epidural catheter and throughout the therapy. Patients using epidural analgesics for chronic pain are monitored for respiratory problems
The relay station for incoming sensory stimuli, such as pain, is the HYPOTHALAMUS. True or false?
FALSE. In the brain, the THALAMUS is a relay station for incoming sensory stimuli, including pain.
What part of the brain serves as the RELAY STATION for incoming sensory stimuli, including PAIN.
THALAMUS
A patient is suffering from a migraine headache. What is the action of sumatriptan (Imitrex)?
Binding to serotonin to produce vasoconstriction
A 40-year-old male client with arthritis of the knee joint has been prescribed an analgesic to relieve the pain. Which of the following is a narcotic analgesic?
Morphine
Analgesia means...
Relief from pain
Analgesic drugs are...
Painkillers
What is an opiod antagonist?
An opioid antagonist, or opioid receptor antagonist, is a receptor antagonist that acts on opioid receptors. Naloxone, (Narcan) and naltrexone are commonly used opioid antagonist drugs which are competitive antagonists that bind to the opioid receptors wi
What is an opiate agonist?
An agonist is an agent that binds to a receptor and activates that receptor in order to elicit an effect (typically transmitting a signal to the inside of the cell, either by opening a channel to allow ions to flow in/out, or changing the receptor's shape
What is an opiod?
Substances that act on the nervous system in a similar way to opiates such as morphine and codeine. In a medical context the term usually indicates medications that are artificially made rather than extracted from opium.
What is an opiate?
Analgesic alkaloid compounds found naturally in the opium poppy plant Papaver somniferum.[1] The psychoactive compounds found in the opium plant include morphine, codeine, and thebaine. The term opiate should be differentiated from the broader term opioid
A client is to receive a narcotic cough syrup. The nurse would expect this preparation to contain which of the following?
Codeine
Although naloxone (Narcan) is given to counter opioid medication side effects such as respiratory depression, what additional issues (if any) may result from administration of an opioid antagonist?
Increase in the client's pain rating. An opioid antagonist will counter not only the negative effects of an opioid medication but the beneficial effects of the opioid (such as pain relief) as well, resulting in an increase in the client's pain rating. It
Opioid antagonists may produce withdrawal symptoms in patients physically dependent on which of the following?
Opioids
Which agent would be used as part of a treatment plan for narcotic detoxification?
Methadone. Methadone is used for detoxification and temporary maintenance treatment of narcotic addition. Oxycodone is used for the relief of moderate to severe pain in adults. Oxymorphone is used for the relief of moderate to severe pain in adults, preop
A patient has been administered an opioid. For which of the following effects should the patient be assessed?
Hypotension. Opioids will produce hypotension due to the effect on the vasomotor center.
The nurse is caring for a postoperative client with a history of opioid abuse who has been ordered to receive a dose of an opioid antagonist medication. Which of the following issues should the nurse be prepared to address?
The client may begin to demonstrate symptoms of withdrawal.
How quickly does naloxone (Narcan) work to reverse opioid induced respiratory depression?
1 to 2 minutes
A group of students are reviewing the various methods for assessing pain. The students demonstrate understanding of the material when they identify which of the following as the most reliable method?
Using a pain rating scale
The nurse explains to the client that sumatriptan is administered at the onset of the migraine headache, and may be readministered no sooner than when?
One hour after first dose if pain is not relieved
Explanation:
Sumatriptan should be administered at the onset of the headache and a second dose can be injected after one hour if pain has not been relieved. There cannot be more than two injections in a 24
Opioid antagonists such as naloxone (Narcan) should be used cautiously in clients who have which of the following conditions? Select all that apply.
� Women who are pregnant
� Infants of opioid-dependent mothers
� Women who are breastfeeding an infant
Antagonists are contraindicated in those with a hypersensitivity to the opioid antagonists. Antagonists are used cautiously in those who are pregnant (p
Prior to administering morphine, the nurse checks the client's medication history. The nurse will contact the physician and hold the morphine if the nurse notes the client is currently taking which medication?
Monoamine oxidase (MAO) inhibitor
Explanation:
The client should not receive morphine within 14 days of receiving an MOA inhibitor. Monoamine oxidase inhibitors are chemicals which inhibit the activity of the monoamine oxidase enzyme family. They have a l
A nurse has just administered an IM injection of meperidine (Demerol) to a patient. The priority nursing action for the nurse will be to
Make sure the side rails are up.
Demerol (Meperidine)
Relief of moderate to severe pain, for preoperative medication, for support of anesthesia, and for obstetric analgesia.
When administering an opioid antagonist drug to a client, the primary goal of the therapy is to provide which of the following?
A return to normal respiratory rate, rhythm, and depth
The nurse is caring for a postoperative client receiving an opioid medication for pain management. The nurse finds the client lethargic with a respiratory rate of 6 breaths per minute. Which of the following actions should be performed first?
Attempt to arouse the client and coach his or her breathing pattern.
A client is receiving drug therapy for prevention of an acute migraine attack. Which agent would be the most helpful?
Ergotamine, an ergot derivative, would be most appropriate for the prevention and treatment of an acute migraine attack. Triptans such as sumatriptan and eletriptan are used for treatment of an acute migraine but not prevention.
A client's family asks why the nurse has placed suction equipment in the room immediately after administering a dose of naloxone (Narcan). Which of the following explanations by the nurse is correct?
Abrupt reversal of opioid-induced respiratory depression may cause vomiting.
Which of the following clients is more likely to have respiratory depression when receiving an opioid medication, requiring administration of an opioid antagonist?
A surgical client who is not used to taking opioid analgesics
The nurse has just administered an opioid antagonist to a client who had been experiencing respiratory depression. How soon can the nurse expect to see improvement in the client's respiratory function?
Within one to five minutes, an effect may be seen.
Morphine, an opioid agonist, is administered for both acute and chronic pain. Along with the administered dosage, which of the following determines the patient's response to morphine?
ROUTE of administration
Nate is a 24-year-old man, status post motor vehicle accident, with multiple broken bones including two rib fractures. The physician prescribes a morphine PCA pump for the patient's pain. When you assess Nate, you find clear breath sounds bilaterally, a r
Ineffective airway clearance secondary to cough suppression by the drug. The most appropriate diagnosis based on the assessment of Nate is ineffective airway clearance secondary to his weak cough. He does have pain and altered mobility, but the PRIORITY n
A man 80 years of age has been prescribed oxycodone (OxyContin) for severe, noncancer, chronic pain. He tells the nurse that he has difficulty swallowing and asks if he can crush the tablet before swallowing. What will the nurse need to advise the client?
The tablet provides around-the-clock pain management and should not be crushed, chewed, or broken.
The nurse is administering morphine sulfate to a client who had a myocardial infarction. What vital sign would the nurse monitor that directly relates to the use of this narcotic?
Respiratory rate
When evaluating the plan of care for a client receiving opioid analgesics for pain management, the nurse considers the plan successful when which of the following occurs? Select all that apply.
� Therapeutic response is achieved and discomfort is reduced.
� An adequate breathing pattern is maintained.
� Client maintains adequate nutritional status.
The nurse knows that, of the following clients, who is least likely to be prescribed transdermal fentanyl?
A woman 85 years of age
A patient is given regular doses of morphine for a period of 6 months. His dosage now needs to be reduced gradually. The physician advises the nurse to pay attention to the clinical management of the patient's pain to allow proper agonist coverage during
Physical dependence on the drug
A patient receives butorphanol via nasal spray. The nurse understands that a repeat dose may be administered in what time frame?
60 to 90 minutes
A nurse is caring for a patient who has to be administered an opioid antagonist. Which of the following should the nurse confirm to ensure that administration of opioid antagonist is not contraindicated in the patient?
Patient is not hypersensitive to the opioid antagonist
The nurse is caring for a postoperative client taking an opioid medication for pain. The nurse assesses the client to have bradypnea and an oxygen saturation value of 90%. Which of the following actions should the nurse perform before administering the or
Assess the client's other vital signs.
Morphine, when administered orally, has a duration of action of 5 to 7 hours.
True
A nurse should recognize the common adverse effects of opioids. Which of the following are examples of common adverse effects seen with the use of opioids? Select all that apply:
� Constipation
� Respiratory depression
� Mydriasis (EXCESSIVE dilation of pupil)
Both categories of migraine abortive drugs (ergot alkaloids and serotonin agonists) exert powerful vasoconstrictive effects and also have what potential?
Raise blood pressure
A nurse is caring for a patient who has to be administered an opioid antagonist. Which of the following should the nurse confirm to ensure that administration of opioid antagonist is not contraindicated in the patient?
Patient is not hypersensitive to the opioid antagonist
Which of the following equipment should be placed in the client's room when administering an opioid antagonist? Select all that apply.
� A pulse oximeter to monitor the client's oxygen saturation levels
� A cardiac monitor to assess the client's cardiac function
� Suction equipment in case the client begins to vomit
A patient has been administered an opioid. For which of the following effects should the patient be assessed?
Hypotension
What is wrong with this order: Fentanyl PO 1 mg q 4 hours for a 6-year-old in severe pain after surgery
Fentanyl is not administered by the oral route. The other medication orders are acceptable for the patients identified in each of the answers.
A nurse is caring for a client diagnosed with migraine headaches. Which of the following nursing interventions should be implemented during an acute headache?
Sumatriptan succinate (Imitrex) should be administered. Ergotamine is administered sublingually. Diclofenac and naproxen are NSAIDs.
A woman has presented to the emergency department after cutting her hand badly on the blade of a food processor. The pain that this woman is currently experiencing is the result of...
Activation of the woman's delta and C nociceptors. Nociceptic pain is caused by the activation of the delta and C nociceptors in response to painful stimuli, such as injury. The sensation of pain is not the result of potassium release, though this does oc
Which of the following should a nurse recognize as the mechanism of action for almotriptan (Axert)? Select all that apply:
� Vasoconstriction
� Decreased neurotransmission
What factors affect how the patient will experience and respond to pain? (Choose all that apply.)
� Cultural expectation about how one should respond to pain
� Past experience with pain
� Learned behavior from childhood
When evaluating the plan of care for a client receiving opioid analgesics for pain management, the nurse considers the plan successful when which of the following occurs? Select all that apply.
� An adequate breathing pattern is maintained.
� Therapeutic response is achieved and discomfort is reduced.
� Client maintains adequate nutritional status.
Which of the following would the nurse expect to assess in a client receiving a narcotic for pain relief?
Orthostatic hypotension. Narcotics are associated with orthostatic hypotension, pupil constriction, constipation, and respiratory depression with apnea.
In which of the following patients should the nurse question the physician's order for IV morphine?
A 78-year-old female with osteoarthritis. Opioid analgesics should be used cautiously in older adults, especially if they are debilitated. Treatment with morphine 1 day after mastectomy is appropriate for pain management. The treatment of pain with morphi
The nurse is preparing a class on narcotic agonists and their use during pregnancy and lactation. The nurse would include which agent as being classified as pregnancy category B?
Oxycodone. Oxycodone is classified as a pregnancy category B drug. Fentanyl is classified as a pregnancy category C drug. Propoxyphene is classified as a pregnancy category C drug. Sufentanil is classified as a pregnancy category C drug.
The nurse is to administer an opioid antagonist. The nurse knows that the valid reasons for administering this type of medication include which of the following? Select all that apply.
� Adverse effects related to opioid administration
� Suspected or known acute opioid overdosage
� Postoperative acute respiratory depression
Your client is taking sumatriptan (Imitrex) for migraine headaches. For which of the following clients is this medication contraindicated?
For clients with a history of angina pectoris, myocardial infarction, or uncontrolled hypertension
A female client tells the nurse that the first thing she does when she gets a headache is drink a caffeinated beverage. The nurse is aware that caffeine is known to decrease the pain of migraine headaches by what mechanism?
Vasoconstriction of blood vessels
A nurse is required to administer an opioid to a patient. Which of the following conditions should the nurse confirm in the patient to ensure that opioid therapy is not contraindicated in this patient?
Patient does not have acute bronchial asthma.
Which assessment finding would support a client's report of migraine headaches?
Severe unilateral pulsating pain
When reviewing the medical history of a patient who is to receive ergotamine, which of the following would alert the nurse to the need for close monitoring?
Pruritus (Severe itching) - Ergot derivatives should be used cautiously in patients with pruritus because it could become worse with the drug inducing vascular vasoconstriction.