Lilley Chapter 11: Analgesic Drugs Flashcards
A patient needs to switch analgesic drugs secondary to an adverse reaction to the current treatment regimen. The patient is concerned that the new prescription will not provide optimal pain control. The nurse’s response is based on knowledge that doses of analgesics are determined using an equianalgesic table with which drug prototype?
A. morphine
B. oxycodone
C. codeine
D. fentanyl
A. morphine
An equianalgesic table is a conversion chart for commonly used opioids. It identifies oral and parenteral dosages that provide comparable analgesia. The equianalgesic table identifies dosages of various narcotics that are equal to 10 mg of morphine. It is important to use when changing to a new opioid or different route. Morphine is the drug prototype for all opioid drugs.
The nurse is caring for a patient with opioid addiction. The nurse anticipates that the patient will be prescribed which medication?
A. morphine sulphate (MS Contin®)
B. meperidine hydrochloride (Demerol®)
C. methadone hydrochloride (Metadol®)
D. naloxone hydrochloride
C. methadone hydrochloride (Metadol®)
Methadone is a synthetic opioid analgesic with gentler withdrawal symptoms and is the drug of choice for detoxification treatment.
While admitting a patient for treatment of an acetaminophen (Tylenol®) overdose, the nurse prepares to administer which medication to prevent toxicity?
A. acetylcysteine
B. phytonadione (vitamin K)
C. naloxone hydrochloride
D. ibuprofen
A. acetylcysteine
Acetylcysteine is the antidote for acetaminophen overdose. It must be administered as a loading dose of 140 mg/kg oral, followed by subsequent doses of 70 mg/kg every 4 hours for 17 additional doses and started as soon as possible after the acetaminophen ingestion (ideally within 10 hours of an overdose).
A patient prescribed massage therapy for musculoskeletal pain asks the nurse, “How is rubbing my muscles going to make the pain go away?” What is the nurse’s best response?
A. “Massaging muscles activates small sensory nerve fibres that send signals to the spinal cord to open the gate and allow endorphins to reach the muscles and relieve the pain.”
B. “Massaging muscles helps relax the contracted fibres and decrease painful stimuli.”
C. “Massaging muscles decreases the inflammatory response that initiates the painful stimuli.”
D. “Massaging muscles activates large sensory nerve fibres that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain.”
D. “Massaging muscles activates large sensory nerve fibres that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain.”
The gate theory of pain control identifies large sensory nerve fibres that when stimulated send signals to the spinal cord to close the gate, blocking pain stimuli from reaching the brain. Therefore, the patient does not have the sensation of pain even if the stimulus is still present.
When assessing for the most serious adverse effect of an opioid analgesic, what does the nurse monitor for?
A. Respiratory rate
B. Blood pressure
C. Heart rate
D. Mental status
A. Respiratory rate
The most serious adverse effect of opioid analgesics is respiratory depression.
Which medication is used to treat a patient with severe adverse effects of a narcotic analgesic?
A. methylprednisolone (Solu-Medrol®)
B. naloxone hydrochloride
C. flumazenil
D. acetylcysteine
B. naloxone hydrochloride
Naloxone is a narcotic antagonist that will reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.
A patient with a diagnosis of pneumonia asks the nurse, “Why am I receiving codeine when I have no pain?” The nurse’s response is based on knowledge that codeine sulphate also does or has the effect of which of the following?
A. A cough suppressant
B. Increases sputum production
C. A bronchodilator
D. An expectorant
A. A cough suppressant
Codeine provides both analgesic and antitussive (cough suppressant) therapeutic effects.
In monitoring a patient for adverse effects related to morphine sulphate (MS Contin), the nurse assesses for stimulation of which area in the central nervous system?
A. The chemoreceptor trigger zone
B. The cough reflex center
C. Sympathetic baroreceptors
D. Autonomic control over circulation
A. The chemoreceptor trigger zone
Morphine sulphate can irritate the gastrointestinal (GI) tract, causing stimulation of the chemoreceptor trigger zone in the brain, which in turn causes nausea and vomiting.
The nurse is preparing to administer an intravenous injection of morphine to a patient. The nurse assesses a respiratory rate of 10 breaths/min. Which action should the nurse perform?
A. Withhold the medication and notify the health care provider.
B. Check the pulse oximeter reading and re-evaluate respiratory rate in 1 hour.
C. Administer a smaller dose and document it in the patient’s record.
D. Administer the next prescribed dose intramuscularly.
A. Withhold the medication and notify the health care provider.
Respiratory depression is an adverse effect of opioid analgesia. Therefore, because the patient’s respiratory rate is below normal, the nurse should withhold the morphine and notify the health care provider.
A patient receiving narcotic analgesics for chronic pain can minimize the GI side effects by
A. taking the medication on an empty stomach.
B. eating foods high in lactobacilli.
C. increasing fluid and fibre in the diet.
D. taking Lomotil® with each dose.
C. increasing fluid and fibre in the diet.
Narcotic analgesics decrease intestinal motility, leading to constipation. Increasing fluid and fibre in the diet can prevent constipation.
The nurse teaches a patient who has been prescribed the fentanyl (Duragesic) transdermal delivery system to change the patch at what interval?
A. Every 12 hours
B. Every 72 hours
C. When pain recurs
D. Every 24 hours
B. Every 72 hours
The fentanyl transdermal delivery system is designed to slowly release analgesic over a 72-hour time frame.
The nurse plans pharmacological management for a patient with pain. The nurse should administer the pain medication on the basis of which of the following?
A. The analgesic should be administered when the pain level reaches a 6 on a scale of 1 to 10.
B. Analgesics should be administered as needed (prn) to minimize adverse effects.
C. To prevent drug addiction, opioid analgesics should not be used for more than 24 hours.
D. Pain relief is best obtained by administering analgesics around the clock.
D. Pain relief is best obtained by administering analgesics around the clock.
When pain is present for more than 12 hours a day, analgesic dosages are best administered around the clock rather than on an as-needed basis, but dosages should always be within the dosage guidelines for each drug used. Around-the-clock (or scheduled) dosing maintains steady-state levels of the medication and prevents drug troughs and the escalation of pain.
In developing a plan of care for a patient receiving morphine sulphate (MS Contin), which nursing diagnosis has the highest priority?
A. Constipation related to decreased GI motility
B. Acute pain related to metastatic tumour cancer
C. Impaired gas exchange related to respiratory depression
D. Risk for injury related to central nervous system adverse effects
C. Impaired gas exchange related to respiratory depression
According to Maslow’s hierarchy of needs and the ABCs of prioritization, impaired gas exchange is a priority over pain, constipation, and risk for injury. If a patient cannot oxygenate sufficiently, all of the other problems will not matter because the patient will not live to worry about them.
