Mod 10- Narcotics, Narcotic Antagonists and Antimigraine Agents

Question 1

The nurse enters the client’s room to see how the client’s pain level is because PRN Demerol can be given. The client is sitting up in bed laughing and visiting with family. The client states that the pain is a “10” on a pain scale of 0 to 10. What is the best response by the nurse?

Answer 1

Administer the pain medication as ordered.

Question 2

Naloxone (Narcan) will reverse the effects of which drug?

Fentanyl (Duragesic) Lorazepam (Ativan) Valproic Acid (Depakote) Warfarin (Coumadin)

Answer 2

Fentanyl (Duragesic)

Question 3

The nurse works in a long-term care facility. When administering narcotics to clients, the nurse must monitor for which side effect?

Answer 3

Constipation

Question 4

Morphine, an opioid agonist, is administered for both acute and chronic pain. Along with the administered dosage, what determines the patient’s response to morphine?

Answer 4

The route of administration

Question 5

After administration of sumatriptan, the client reports experiencing nausea. Which drug does the nurse anticipate the prescriber to order?

Answer 5

chlorpromazine
Antiemetics and opioids are used as adjuvant medications for severe migraine headaches. Chlorpromazine is a phenothiazine that has been shown to be effective for migraines and for nausea and vomiting. Amitriptyline and imipramine are tricyclic antidepressants. Feverfew is an herbal supplement. None of these options have an antiemetic effect.

Question 6

A client’s healthcare provider has prescribed meperidine 75 mg PO q4h PRN for the client’s chronic pain. What education should the nurse provide to this client regarding this medication?

Answer 6

“Avoid drinking alcohol while taking meperidine.”

Drinking alcohol during narcotic treatment can exacerbate CNS depression.

Question 7

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

Answer 7

Fentanyl is available as a transdermal patch.

Question 8

The nurse is assessing a new client whose medication regimen includes estradiol, which the client states that she is taking for the treatment of migraines. The nurse should recognize the need to assess what?

Answer 8

menstrual cycles
Estrogen in the form of estradiol is a treatment for menstrual migraines, which are most likely 2 days prior to menses through the 3rd day of bleeding. Because of the likelihood of this etiology, it is appropriate for the nurse to discuss the client’s menstrual cycles with her. Adverse effects do not normally involve the integumentary or respiratory systems. The etiology of the client’s migraines more likely involves physiology than psychosocial factors, so the nurse should assess accordingly.

Question 9

A nurse is caring for a 49-year-old client in the intensive care unit. The client was in a motor vehicle accident and is in severe pain. The client has been given morphine. After 2 days in the unit, the nurse can detect nasal congestion when the client speaks to her. The nurse will monitor for which?

Answer 9

pneumonia.
Explanation:
Respiratory depression is a common adverse effect of morphine. If the client gets a cold, as the nasal congestion can be a sign, this respiratory depression could cause retained secretions and put the client at greater risk for developing pneumonia.

Question 10

A client has been administered an opioid. For what effect should the nurse regularly assess?

Answer 10

Opioids will produce decreased LOC.

Question 11

The nurse is administering opioid analgesics to a client for postoperative pain. What is the nurse’s most important assessment prior to administering the medication?

Answer 11

Respiratory rate
Explanation:
The most important assessment that the nurse can make prior to administration of an opioid is the respiratory rate because the most serious adverse complication of opioid use is respiratory depression.

Question 12

Naproxen has been prescribed to a client whose increasingly severe migraines are interfering with work performance and family life. When providing health education to this client, the nurse should instruct the client to consider what intervention when taking the medication?

Answer 12

Take the pills with meals to minimize stomach upset.
Explanation:
Naproxen should be taken on a full stomach. The pills should not be crushed. Constipation is not a noted adverse effect, and regular blood work is not warranted.

Question 13

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

Answer 13

codeine.
Explanation:
Typically, codeine or hydrocodone are used to relieve coughing.

Question 14

A client’s family asks why the nurse has placed suction equipment in the room immediately after administering a dose of naloxone. Which explanation by the nurse is correct?

Answer 14

Abrupt reversal of opioid-induced respiratory depression may cause vomiting

Question 15

Which medication order should a nurse question?

Answer 15

Fentanyl PO 1 mg q 4 hours for a 6-year-old in severe pain after surgery
Explanation:
Fentanyl is not administered by the oral route.

Question 16

When describing the onset of action of naloxone, the nurse would explain that the drug achieves its effect in which amount of time?

Answer 16

1 to 2 minutes

Question 17

A nurse has entered a client’s room at the beginning of a shift to quickly assess the client’s airway, breathing, circulation, and consciousness. The nurse observes that the client is wincing, stating, “ Oh, I am in so much pain right now.” What initial question should the nurse ask this client?

Answer 17

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. Questions about preferred treatments and the timing of the pain are appropriate and important, but it is normally necessary to first ascertain the location of the client’s pain.

Question 18

The nurse is reviewing the medication history of a client newly diagnosed with cluster headaches. The client’s concurrent use of what medication would contraindicate treatment with frovatriptan?

Answer 18

Fluoxetine
Explanation:
Frovatriptan interacts unfavorably with selective serotonin reuptake inhibitors and may lead to serotonin syndrome. Neither albuterol, metformin, nor atorvastatin presents a risk for drug interactions.

Question 19

A client is prescribed zolmitriptan for migraine headaches. The nurse should instruct the client to administer this drug by which route?

Answer 19

Zolmitriptan is administered by either the oral route or intranasally. It is not currently available by either a transdermal patch or subcutaneous injection.

Question 20

Prior to administering morphine, the nurse checks the client’s medication history. The nurse will contact the health care provider and hold the morphine if the nurse notes the client is currently taking which medication?

Answer 20

Monoamine oxidase (MAO) inhibitor

Question 21

A client who lives with chronic pain has just learned that she is pregnant. What narcotic analgesic is most appropriate for this client?

Answer 21

Oxycodone
Explanation:
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.

Question 22

The nurse knows that, of the following clients, who is least likely to be prescribed transdermal fentanyl?

Answer 22

A woman 85 years of age
Explanation:
The transdermal route of medication administration is dependent upon the amount of subcutaneous tissue present for medication distribution. Subcutaneous tissue is reduced as a result of the aging process. Therefore, the client 85 years of age would be least likely to be prescribed a transdermal medication. The clients 25, 35 and 50 years of age would have adequate subcutaneous tissue for medication distribution.