Week 11: Pharmacology of Opioids

Question 1

A 45-year-old patient is being treated for chronic pain with long-acting opioids. The nurse is teaching the patient about the medication regimen. Which statement by the patient indicates the need for further teaching?

A) “I should take my long-acting opioid exactly as prescribed and not adjust the dose if I experience breakthrough pain.”
B) “I should notify my healthcare provider if I experience any side effects, even if they are mild.”
C) “Long-acting opioids are used for continuous pain control and allow me to take fewer doses throughout the day.”
D) “I can take my long-acting opioid every 8 hours, but if I have breakthrough pain, I can take short-acting opioids as needed.”

Answer 1

Answer: A) “I should take my long-acting opioid exactly as prescribed and not adjust the dose if I experience breakthrough pain.”

Rationale: Long-acting opioids are used for continuous pain control and have a scheduled dosing interval. Breakthrough pain may occur, and short-acting opioids are typically prescribed for such instances. The patient should not adjust the dose of long-acting opioids on their own without consulting their healthcare provider

Question 2

A nurse is assessing a patient who is experiencing acute pain due to an injury. Which of the following is the most appropriate initial intervention for managing this patient’s pain?

A) Administer an opioid analgesic and schedule reassessment after 4 hours.
B) Perform a comprehensive pain assessment using the OPQRSTUV mnemonic.
C) Apply a cold compress to the injured area to relieve pain.

D) Encourage the patient to perform physical therapy exercises to reduce pain.

Answer 2

Answer: B) Perform a comprehensive pain assessment using the OPQRSTUV mnemonic.

Rationale: The first step in managing pain is to assess it thoroughly using a structured approach such as the OPQRSTUV mnemonic. This helps to understand the onset, severity, quality, and other aspects of the pain, which will guide appropriate interventions.

Question 3

A nurse is educating a patient on the use of opioid medications for pain management. Which of the following side effects should the nurse specifically discuss as a common concern with opioid use?

A) Hypertension
B) Respiratory depression
C) Insomnia
D) Bradycardia

Answer 3

Answer: B) Respiratory depression

Rationale: Respiratory depression is a well-known and potentially life-threatening side effect of opioid medications. The nurse should educate the patient about the signs of respiratory depression and ensure they understand the importance of seeking medical help if symptoms occur.

Question 4

A patient with a history of opioid addiction is admitted for surgery. The healthcare provider prescribes methadone for pain management. Which of the following is the most important nursing intervention related to this prescription?

A) Monitor the patient’s cardiac rhythm, as methadone can affect the electrical conduction of the heart.
B) Administer methadone immediately before surgery to ensure pain relief.
C) Encourage the patient to take methadone only when they experience severe pain.
D) Assess the patient’s kidney function, as methadone is primarily eliminated through the kidneys.

Answer 4

Answer: A) Monitor the patient’s cardiac rhythm, as methadone can affect the electrical conduction of the heart.

Rationale: Methadone can cause irregular heart rhythms and affect the electrical conduction of the heart. It is important to monitor the patient’s cardiac rhythm, especially when starting methadone therapy.

Question 5

A nurse is providing education to a patient who has been prescribed oxycodone for moderate pain management. The nurse should caution the patient about which of the following potential interactions with oxycodone?

A) Taking the medication with vitamin C can enhance its effectiveness.
B) Taking the medication with a strong CYP2D6 inhibitor, such as paroxetine, may lead to increased levels of oxycodone.
C) Taking the medication with food will reduce the absorption of oxycodone.
D) Taking the medication with an anti-inflammatory drug like ibuprofen will reduce the risk of constipation.

Answer 5

Answer: B) Taking the medication with a strong CYP2D6 inhibitor, such as paroxetine, may lead to increased levels of oxycodone.

Rationale: CYP2D6 inhibitors, such as paroxetine, can affect the metabolism of oxycodone, leading to increased levels of the drug in the bloodstream. This can increase the risk of side effects, including respiratory depression.

Question 6

A 60-year-old patient is prescribed fentanyl for chronic cancer pain management. The nurse is educating the patient about the use of a transdermal fentanyl patch. Which of the following instructions should the nurse include?

A) “You can apply a new patch anywhere on your body, as long as the skin is intact.”
B) “The patch will start working within 5 minutes, but it may take up to 24 hours to reach full effect.”
C) “Do not expose the patch to direct heat, as it can cause the medication to be released too quickly.”
D) “Once the patch is applied, you do not need to worry about reassessing your pain for the next 72 hours.

Answer 6

Answer: C) “Do not expose the patch to direct heat, as it can cause the medication to be released too quickly.”

Rationale: Direct heat can increase the rate at which fentanyl is released from the transdermal patch, leading to potentially dangerous levels of the medication in the bloodstream. Patients should be educated to avoid exposing the patch to heat sources, such as heating pads or hot tubs.

Question 7

A nurse is assessing a patient’s pain using the OPQRSTUV mnemonic. The patient describes their pain as “sharp and stabbing” and mentions it started suddenly, but the pain is now gradually becoming less intense. The nurse should document the pain as:

A. Acute
B. Chronic
C. Neuropathic
D. Nociceptive

Answer 7

Correct Answer: A. Acute
Rationale: Acute pain is sudden, intense, and typically serves as a warning of injury or threat to the body. The description of “sharp and stabbing” fits acute pain, which is often short-lived and lessens as healing occurs.

Question 8

A patient has been prescribed codeine for mild pain. Which statement by the nurse is accurate regarding the pharmacokinetics of codeine?

A. Codeine is metabolized into morphine in the liver by the CYP2D6 enzyme.
B. Codeine has no active metabolites and thus does not provide effective pain relief.
C. The CYP2D6 enzyme prevents codeine from being converted into its active form.
D. Codeine does not cross the blood-brain barrier, making it ineffective for pain relief.

Answer 8

Correct Answer: A. Codeine is metabolized into morphine in the liver by the CYP2D6 enzyme.
Rationale: Codeine is a prodrug, and it is converted into morphine (its active form) in the liver by the CYP2D6 enzyme. This process is essential for its analgesic effect.

Question 9

A nurse is educating a patient who will be prescribed a long-acting opioid for pain management. Which of the following is the most important consideration when using long-acting opioids?

A. Tapering is required when discontinuing the medication.
B. The medication should be taken only when breakthrough pain occurs.
C. Short-acting opioids should be used as the first line of treatment for chronic pain.
D. Long-acting opioids are usually taken for acute pain.

Answer 9

Correct Answer: A. Tapering is required when discontinuing the medication.
Rationale: Long-acting opioids are used once pain relief is achieved with short-acting opioids. When discontinuing these medications, tapering is necessary to prevent withdrawal symptoms and manage dependency.

Question 10

Which of the following is a key difference between opioid agonists and opioid antagonists?

A. Agonists activate opioid receptors, whereas antagonists block opioid receptors.
B. Agonists block opioid receptors, while antagonists activate opioid receptors.
C. Agonists are used to treat opioid use disorder, while antagonists are used for pain management.
D. Antagonists cause analgesia, while agonists inhibit pain perception.

Answer 10

Correct Answer: A. Agonists activate opioid receptors, whereas antagonists block opioid receptors.
Rationale: Opioid agonists, such as morphine, activate opioid receptors to provide pain relief, while opioid antagonists, such as naloxone, block opioid receptors to reverse opioid effects, particularly in cases of overdose.

Question 11

A nurse is administering hydromorphone to a patient for moderate to severe pain. The nurse is aware that hydromorphone is:

A. Less potent than morphine and has minimal side effects.
B. Stronger than morphine and is metabolized primarily in the liver.
C. A weak opioid that is only effective for mild pain.
D. A non-opioid analgesic that works by inhibiting prostaglandins.

Answer 11

Correct Answer: B. Stronger than morphine and is metabolized primarily in the liver.
Rationale: Hydromorphone is a strong opioid, approximately five times more potent than morphine. It is metabolized by the liver and has similar action to morphine at opioid receptors.

Question 12

A patient with chronic pain has been prescribed methadone. Which of the following should the nurse monitor closely during methadone treatment?

A. Decreased respiratory rate and potential for respiratory depression
B. Increased blood pressure and heart rate
C. Dehydration and kidney function
D. Increased liver enzyme levels due to the hepatic metabolism of methadone

Answer 12

Correct Answer: A. Decreased respiratory rate and potential for respiratory depression
Rationale: Methadone is a long-acting opioid that can cause respiratory depression, particularly when not titrated properly. The nurse should monitor the patient closely for signs of respiratory depression, especially when starting or adjusting the dosage.

Question 13

When assessing a patient’s pain using the Numeric Rating Scale (NRS), the nurse asks the patient to rate their pain from 0 to 10. Which of the following is an important consideration when using the NRS?

A. The NRS should only be used for patients under 12 years of age.
B. The NRS provides a subjective measure of pain intensity.
C. The NRS should not be used in nonverbal patients.
D. The NRS assesses both the intensity and the emotional response to pain.

Answer 13

Correct Answer: B. The NRS provides a subjective measure of pain intensity.
Rationale: The Numeric Rating Scale (NRS) measures the intensity of pain as reported by the patient, offering a subjective assessment of the pain experience. It is used for patients 8 years and older and can be applied to both verbal and nonverbal patients, though modifications may be required.

Question 14

A nurse is caring for a postoperative patient who is using a fentanyl transdermal patch for pain control. Which of the following is an important nursing consideration for fentanyl patch use?

A. The patch should be replaced every 72 hours or as prescribed.
B. The patch should be placed over areas of broken skin to enhance absorption.
C. The patient should be encouraged to engage in vigorous physical activity to increase circulation.
D. The patch should be heated with a heating pad to accelerate the release of the drug.

Answer 14

Correct Answer: A. The patch should be replaced every 72 hours or as prescribed.
Rationale: Fentanyl transdermal patches are typically replaced every 72 hours, as directed by the healthcare provider. Heating pads should not be used with the patch as it can cause an accelerated release of the medication, leading to potential overdose.

Question 15

A nurse is caring for a patient who is receiving opioids for pain management and is concerned about constipation as a side effect. Which of the following is the best strategy to manage opioid-induced constipation?

A. Increase fluid intake and fiber in the diet
B. Administer a stool softener as prescribed
C. Reduce the opioid dose
D. Encourage the patient to avoid physical activity

Answer 15

Correct Answer: B. Administer a stool softener as prescribed
Rationale: Constipation is a common side effect of opioid use due to the activation of mu receptors in the gut. Stool softeners or laxatives may be prescribed to manage this side effect. Increasing fluid intake and fiber can also help, but stool softeners are more direct and effective.

Question 16

A nurse is caring for a patient receiving an opioid for pain management. Which of the following is the priority assessment before administering an opioid to the patient?

A. Respiratory rate
B. Blood pressure
C. Temperature
D. Heart rate

Answer 16

Correct Answer: A. Respiratory rate
Rationale: Opioids can cause respiratory depression, making it crucial to assess the patient’s respiratory rate before administering the medication. A low respiratory rate may indicate the need for dose adjustment or avoidance of the opioid.

Question 17

A patient who has been prescribed morphine for severe pain reports feeling dizzy and lightheaded after taking the medication. The nurse should first:

A. Instruct the patient to drink water to avoid dehydration.
B. Check the patient’s blood pressure and heart rate.
C. Administer naloxone to reverse the effects of morphine.
D. Apply oxygen to improve the patient’s breathing.

Answer 17

Correct Answer: B. Check the patient’s blood pressure and heart rate.
Rationale: Dizziness and lightheadedness may indicate hypotension, a side effect of opioids. The nurse should assess the patient’s blood pressure and heart rate to determine if a dose adjustment or intervention is needed.

Question 18

A patient receiving opioid analgesics for chronic pain is concerned about the possibility of developing a tolerance to the medication. The nurse’s best response is:

A. “Tolerance is not a concern with long-term opioid use.”
B. “Tolerance occurs, meaning you may need higher doses for the same effect over time.”
C. “Tolerance can be prevented by taking the medication at the same time every day.”
D. “Tolerance will be avoided if you combine the opioid with non-opioid analgesics.”

Answer 18

Correct Answer: B. “Tolerance occurs, meaning you may need higher doses for the same effect over time.”
Rationale: Tolerance to opioids develops with long-term use, requiring higher doses to achieve the same level of pain relief. It is important for the patient to understand this to manage expectations and monitor for potential adverse effects.

Question 19

A nurse is caring for a patient who is prescribed acetaminophen for mild pain. The nurse knows that acetaminophen is contraindicated in patients with which of the following conditions?

A. Hypertension
B. Liver disease
C. Renal disease
D. Asthma

Answer 19

Correct Answer: B. Liver disease
Rationale: Acetaminophen is metabolized by the liver, and in patients with liver disease, it can cause liver damage. Therefore, it is contraindicated in patients with liver disease.

Question 20

A patient is prescribed tramadol for pain management. The nurse should be aware that tramadol can increase the risk of which of the following?

A. Seizures
B. Kidney failure
C. Cardiac arrhythmias
D. Hypotension

Answer 20

Correct Answer: A. Seizures
Rationale: Tramadol, an opioid analgesic, can lower the seizure threshold, increasing the risk of seizures, especially in patients with a history of seizures or those taking medications that affect the central nervous system.

Question 21

A patient with chronic pain is being transitioned from an opioid regimen to a non-opioid analgesic. Which of the following strategies should the nurse use to minimize withdrawal symptoms during this transition?

A. Taper the opioid dose gradually over time.
B. Discontinue the opioid abruptly to prevent dependency.
C. Increase the patient’s opioid dosage to prevent withdrawal.
D. Administer a benzodiazepine to manage anxiety during the transition.

Answer 21

Correct Answer: A. Taper the opioid dose gradually over time.
Rationale: Gradual tapering of the opioid dose is the best strategy to minimize withdrawal symptoms, as it allows the body to adjust to lower levels of the drug without causing significant discomfort or adverse effects.

Question 22

A patient is being prescribed an NSAID (nonsteroidal anti-inflammatory drug) for pain relief. Which of the following is the most important instruction for the nurse to provide the patient?

A. “Take the NSAID on an empty stomach to maximize absorption.”
B. “Limit your fluid intake while taking the NSAID to reduce side effects.”
C. “Avoid alcohol while taking the NSAID, as it increases the risk of gastrointestinal bleeding.”
D. “Take the NSAID only when you experience severe pain to avoid dependence.”

Answer 22

Correct Answer: C. “Avoid alcohol while taking the NSAID, as it increases the risk of gastrointestinal bleeding.”
Rationale: Alcohol consumption with NSAIDs increases the risk of gastrointestinal bleeding and ulceration. The nurse should educate the patient on this risk and advise them to avoid alcohol during NSAID therapy.

Question 23

A nurse is caring for a patient who is receiving opioid medication for pain management. The nurse understands that a major risk associated with long-term opioid use is:

A. Hyperglycemia
B. Opioid overdose
C. Addiction or dependence
D. Hyperkalemia

Answer 23

Correct Answer: C. Addiction or dependence
Rationale: One of the major risks associated with long-term opioid use is the development of addiction or physical dependence. This can lead to withdrawal symptoms if the medication is abruptly discontinued.

Question 24

A nurse is preparing to administer morphine sulfate intravenously to a postoperative patient. Which action should the nurse take before administering the morphine?

A. Ask the patient to rate their pain on a 0-10 scale.
B. Administer a dose of naloxone to prevent respiratory depression.
C. Administer the medication rapidly to provide quick relief.
D. Encourage the patient to walk around before administration.

Answer 24

Correct Answer: A. Ask the patient to rate their pain on a 0-10 scale.
Rationale: Before administering morphine, it is essential to assess the patient’s pain level to determine if the opioid is necessary and to ensure the appropriate dose is administered based on the severity of the pain.

Question 25

A nurse is teaching a patient about opioid-induced constipation (OIC) while taking oxycodone for pain management. Which of the following interventions is most effective in managing OIC?

A. Increase dietary fiber and fluid intake.
B. Take an antiemetic before each dose of oxycodone.
C. Use a stool softener and a laxative as prescribed.
D. Limit physical activity to reduce bowel stimulation.

Answer 25

Correct Answer: C. Use a stool softener and a laxative as prescribed.
Rationale: Opioids often cause constipation, so stool softeners and laxatives are commonly prescribed to manage this side effect. Increasing fiber and fluid intake can also help, but stool softeners are a more direct intervention.

Question 26

What is the primary assessment before administering opioids to a patient?

Answer 26

Respiratory rate

Question 27

Name one common side effect of opioid analgesics.

Answer 27

Constipation

Question 28

List one non-pharmacological method to manage pain.

Answer 28

Answer: Meditation

Question 29

What is the risk of taking acetaminophen in high doses?

Answer 29

Answer: Liver damage

Question 30

Identify one medication that can reverse opioid overdose.

Answer 30

Answer: Naloxone

Question 31

What is the term used for the body’s reduced response to a medication over time?

Answer 31

Answer: Tolerance

Question 32

What is a common adverse effect of NSAIDs?

Answer 32

Answer: Gastrointestinal bleeding

Question 33

List one strategy to minimize opioid withdrawal symptoms.

Answer 33

Answer: Gradual tapering

Question 34

What is the major risk of opioid use in patients with a history of substance abuse?

Answer 34

Answer: Addiction

Question 35

Name one key assessment for opioid-induced respiratory depression.

Answer 35

Answer: Oxygen saturation

Question 36

A patient is experiencing sharp, intense pain that started suddenly and is acting as a warning signal. Which type of pain is the patient most likely experiencing?
A. Chronic pain
B. Acute pain
C. Neuropathic pain
D. Nociceptive pain

Answer 36

Answer: B. Acute pain
Rationale:

B (Correct): Acute pain is sudden, sharp, or intense, and serves as a warning signal for potential harm.
A: Chronic pain lasts longer than 90 days, not sudden and sharp.
C: Neuropathic pain is typically described as burning or shooting, not sharp and sudden.
D: Nociceptive pain occurs due to tissue damage, but acute pain specifically refers to the sudden onset.

Question 37

Which of the following describes neuropathic pain?
A. Aching pain due to muscle injury
B. Pain caused by damage to the nervous system
C. Pain from inflammation or tissue damage
D. Deep, cramping pain from internal organs

Answer 37

Answer: B. Pain caused by damage to the nervous system
Rationale:

B (Correct): Neuropathic pain occurs due to lesions or diseases affecting the somatosensory nervous system.
A: Nociceptive pain is associated with muscle injury, not neuropathic pain.
C: Nociceptive pain is caused by tissue damage or inflammation, not nerve damage.
D: Visceral pain arises from internal organs, not from nerve damage.

Question 38

A patient complains of burning, shooting pain in their leg. This type of pain is most likely:
A. Somatic pain
B. Neuropathic pain
C. Visceral pain
D. Acute pain

Answer 38

Answer: B. Neuropathic pain
Rationale:

B (Correct): Neuropathic pain is often described as burning, shooting, or pins and needles.
A: Somatic pain is localized and caused by injury to muscles or skin, not burning or shooting sensations.
C: Visceral pain arises from internal organs and is usually dull or cramp-like.
D: Acute pain is sudden but is not typically described as burning or shooting.

Question 39

Which type of pain results from actual or potential damage to body tissue due to the activation of nociceptors?
A. Somatic pain
B. Chronic pain
C. Nociceptive pain
D. Neuropathic pain

Answer 39

Answer: C. Nociceptive pain
Rationale:

C (Correct): Nociceptive pain occurs when nociceptors are activated due to injury, disease, or inflammation.
A: Somatic pain is a type of nociceptive pain that arises from muscles or skin, but nociceptive pain is a broader category.
B: Chronic pain is pain lasting longer than 90 days, but it does not specifically relate to nociceptor activation.
D: Neuropathic pain results from nerve damage, not nociceptor activation

Question 40

Which of the following describes somatic pain?
A. Pain caused by damage to the nervous system
B. Pain localized to the skin or muscles
C. Pain from internal organs like the kidneys
D. Pain that lasts for months or years

Answer 40

Answer: B. Pain localized to the skin or muscles
Rationale:

B (Correct): Somatic pain arises from the skin, muscles, or joints and is usually well-localized.
A: Neuropathic pain is related to nerve damage, not somatic pain.
C: Visceral pain arises from internal organs like the kidneys, not somatic pain.
D: Chronic pain lasts longer than 90 days, not specifically related to somatic pain.

Question 41

Instructions: Match the type of pain with the correct description.
Acute pain
Chronic pain
Neuropathic pain
Nociceptive pain
Somatic pain
Visceral pain

A. Pain caused by nerve damage, often described as burning or shooting
B. Sudden, sharp, intense pain, usually lasting for a short time
C. Pain from internal organs, often described as dull or cramp-like
D. Pain arising from muscles or skin, well-localized
E. Pain that persists for longer than 90 days
F. Pain due to activation of nociceptors from tissue damage or inflammation

Answer 41

Answers:

B - Acute pain: Sudden, sharp, and intense, usually acting as a warning signal.
E - Chronic pain: Pain lasting longer than 90 days, persisting even after the initial injury has healed.
A - Neuropathic pain: Caused by damage to the somatosensory nervous system, often described as burning or shooting.
F - Nociceptive pain: Pain caused by activation of nociceptors due to tissue damage or inflammation.
D - Somatic pain: Arises from the skin, muscles, or joints, and is typically well-localized.
C - Visceral pain: Arises from internal organs and is often described as dull, cramp-like, or deep.

Question 42

Codeine is considered a weak opioid because it:
A. Produces more pain relief than morphine
B. Is less effective than morphine in treating pain
C. Acts directly on the brain without requiring conversion
D. Has a higher risk of addiction than stronger opioids

Answer 42

Answer: B. Is less effective than morphine in treating pain
Rationale:

B (Correct): Codeine is considered a weak opioid because it provides less pain relief than morphine. It is typically used for mild to moderate pain.
A (Incorrect): Morphine is stronger than codeine and more effective for severe pain.
C (Incorrect): Codeine is a prodrug, meaning it needs to be converted into morphine in the liver to become effective.
D (Incorrect): While all opioids carry some risk of addiction, codeine is considered less potent and has a lower risk compared to stronger opioids like morphine.

Question 43

What percentage of a dose of codeine is converted into its active form, morphine, in the liver?
A. 10%
B. 25%
C. 50%
D. 75%

Answer 43

Answer: A. 10%
Rationale:

A (Correct): About 10% of each dose of codeine is converted into morphine, the active form of the drug, in the liver.
B, C, D (Incorrect): These percentages are not correct. Only about 10% of codeine is metabolized into morphine.

Question 44

Which enzyme is responsible for converting codeine into its active form, morphine?
A. CYP2D6
B. CYP3A4
C. CYP2C9
D. CYP1A2

Answer 44

Answer: A. CYP2D6
Rationale:

A (Correct): The enzyme CYP2D6 is responsible for converting codeine into morphine in the liver.
B, C, D (Incorrect): CYP3A4, CYP2C9, and CYP1A2 are enzymes involved in the metabolism of other drugs, but not in the conversion of codeine to morphine.

Question 45

Which group of patients may find codeine ineffective due to their metabolism?
A. Those with a history of liver disease
B. Ultra-rapid metabolizers of CYP2D6
C. Patients with a high tolerance to opioids
D. Patients using acetaminophen regularly

Answer 45

Answer: B. Ultra-rapid metabolizers of CYP2D6
Rationale:

B (Correct): Ultra-rapid metabolizers of CYP2D6 have multiple copies of the CYP2D6 gene, causing them to metabolize codeine too quickly. This results in codeine being ineffective because it is converted too fast to morphine.
A (Incorrect): While liver disease can affect drug metabolism, it doesn’t specifically affect ultra-rapid metabolizers.
C (Incorrect): A high tolerance to opioids may affect the efficacy of codeine, but it is not related to the enzyme activity described here.
D (Incorrect): Regular use of acetaminophen does not affect codeine’s metabolism by CYP2D6.

Question 46

Which of the following is an additional, non-pain-related use for codeine?
A. To treat asthma
B. As a cough suppressant
C. To reduce fever
D. To manage high blood pressure

Answer 46

Answer: B. As a cough suppressant
Rationale:

B (Correct): Codeine is commonly used as a cough suppressant due to its ability to suppress the cough reflex.
A (Incorrect): Codeine is not used to treat asthma.
C (Incorrect): Codeine does not reduce fever; it is used for pain and cough.
D (Incorrect): Codeine is not used to treat high blood pressure.

Question 47

Codeine is used to treat excessive diarrhea in patients with an ileostomy. Which condition does codeine help manage in these patients?
A. Inflammatory bowel disease (IBD)
B. Crohn’s disease
C. Ulcerative colitis
D. Both A and B

Answer 47

Answer: D. Both A and B
Rationale:

D (Correct): Codeine is used to help manage excessive diarrhea in patients with an ileostomy, particularly those diagnosed with inflammatory bowel disease (IBD), which includes conditions like Crohn’s disease and ulcerative colitis.
A, B, C (Incorrect): Although codeine helps manage diarrhea, it’s the specific use for IBD-related diarrhea, rather than treating the underlying diseases themselves.

Question 48

Which of the following are non-pain-related uses for codeine? (Select all that apply)
A. To treat a severe cough
B. To manage excessive diarrhea in patients with ileostomy
C. As a sedative for anxiety
D. To treat chronic pain
E. As a treatment for asthma

Answer 48

Answers: A, B
Rationale:

A (Correct): Codeine is an effective cough suppressant and is used to treat severe coughs.
B (Correct): Codeine is used to manage excessive diarrhea in patients with an ileostomy, especially those with inflammatory bowel disease (IBD).
C (Incorrect): Codeine is not used as a sedative for anxiety. It is an opioid pain reliever and cough suppressant.
D (Incorrect): Codeine is not typically used for chronic pain; it is more commonly used for mild to moderate pain.
E (Incorrect): Codeine is not used to treat asthma. Other medications like bronchodilators are used for asthma management.

Question 49

Which of the following conditions or factors may affect the effectiveness of codeine? (Select all that apply)
A. A history of liver disease
B. Being an ultra-rapid metabolizer of CYP2D6
C. Taking other medications that inhibit CYP2D6
D. Having a high tolerance to opioids
E. Being a slow metabolizer of CYP2D6

Answer 49

Answers: A, B, C
Rationale:

A (Correct): A history of liver disease may affect the metabolism of codeine, as it is processed in the liver. Impaired liver function may lead to reduced conversion to morphine.
B (Correct): Ultra-rapid metabolizers of CYP2D6 convert codeine into morphine too quickly, potentially causing codeine to be ineffective.
C (Correct): Medications that inhibit CYP2D6 can reduce the conversion of codeine to morphine, making codeine less effective.
D (Incorrect): A high tolerance to opioids may affect the analgesic effect but does not directly relate to how codeine is metabolized.
E (Incorrect): Slow metabolizers may have reduced effectiveness of codeine because they do not convert it to morphine efficiently, leading to less pain relief.

Question 50

Which of the following are correct statements about the metabolism of codeine? (Select all that apply)
A. Codeine is a prodrug that must be converted to morphine in the body to be effective.
B. The conversion of codeine into morphine is done primarily by the liver.
C. CYP2D6 enzyme activity can affect how well codeine works in the body.
D. All patients metabolize codeine at the same rate.
E. The prodrug nature of codeine means it can be effective immediately after administration.

Answer 50

Answers: A, B, C
Rationale:

A (Correct): Codeine is a prodrug, meaning it must be converted to morphine (its active form) in the body to be effective.
B (Correct): The conversion of codeine to morphine primarily occurs in the liver, where the CYP2D6 enzyme plays a key role.
C (Correct): The CYP2D6 enzyme activity can affect how well codeine is metabolized. Different people may metabolize it at different rates.
D (Incorrect): Not all patients metabolize codeine at the same rate. Factors such as enzyme activity (CYP2D6) can cause variations in how codeine is metabolized.
E (Incorrect): Codeine must be converted to morphine before it becomes effective, so it does not act immediately.

Question 51

What is the main reason ultra-rapid metabolizers of CYP2D6 may find codeine ineffective? (Select all that apply)
A. They metabolize codeine too quickly, preventing it from providing adequate pain relief.
B. They do not convert codeine to morphine effectively, making it ineffective.
C. Codeine’s effects are intensified in ultra-rapid metabolizers, causing harmful side effects.
D. They metabolize codeine slower than normal, making it ineffective.

Answer 51

Answers: A, C
Rationale:

A (Correct): Ultra-rapid metabolizers of CYP2D6 convert codeine into morphine too quickly, reducing its effectiveness and preventing it from providing adequate pain relief.
B (Incorrect): Ultra-rapid metabolizers convert codeine to morphine faster, not less efficiently.
C (Correct): Since ultra-rapid metabolizers convert codeine to morphine too quickly, it can intensify its effects, leading to harmful side effects such as excessive sedation or respiratory depression.
D (Incorrect): Ultra-rapid metabolizers do not metabolize codeine slower; they metabolize it faster than normal.

Question 52

A nurse is administering morphine to a patient experiencing severe post-operative pain. Morphine provides pain relief by:
A. Blocking the transmission of pain signals in peripheral nerves
B. Mimicking natural opioid peptides at the mu receptors
C. Inhibiting the breakdown of pain-relieving neurotransmitters
D. Reducing inflammation at the site of pain

Answer 52

Answer: B. Mimicking natural opioid peptides at the mu receptors
Rationale:

B (Correct): Morphine relieves pain by mimicking the body’s natural opioids (endogenous opioid peptides) and binding to mu receptors in the CNS and periphery.
A (Incorrect): Morphine does not block peripheral nerve pain signals directly; it works centrally (in the brain and spinal cord).
C (Incorrect): Morphine does not inhibit the breakdown of neurotransmitters; it binds to opioid receptors.
D (Incorrect): Morphine does not have anti-inflammatory properties; NSAIDs (e.g., ibuprofen) are used for inflammation.

Question 53

A patient with kidney disease is prescribed morphine for pain relief. Which factor should the nurse monitor closely in this patient?
A. Risk of hypoglycemia
B. Accumulation of morphine metabolites
C. Increased pain sensitivity
D. Reduced absorption of morphine

Answer 53

Answer: B. Accumulation of morphine metabolites
Rationale:

B (Correct): Morphine is metabolized in the liver and kidneys, producing metabolites like morphine-6-glucuronide. In patients with kidney disease, these metabolites can accumulate, increasing the risk of toxicity (e.g., respiratory depression).
A (Incorrect): Hypoglycemia is not a common concern with morphine use.
C (Incorrect): Morphine reduces pain sensitivity by acting on mu receptors.
D (Incorrect): Morphine is well absorbed; kidney disease affects metabolism and excretion, not absorption.

Question 54

The nurse is educating a patient on the side effects of morphine. Which metabolite of morphine is responsible for analgesia and respiratory depression?
A. Morphine-3-glucuronide
B. Morphine-6-glucuronide
C. CYP2D6 enzyme
D. Glucuronic acid

Answer 54

Answer: B. Morphine-6-glucuronide
Rationale:

B (Correct): Morphine-6-glucuronide is the active metabolite that acts on mu receptors, causing both analgesia (pain relief) and respiratory depression.
A (Incorrect): Morphine-3-glucuronide has no pain-relieving effects but may cause neuroexcitatory effects.
C (Incorrect): CYP2D6 is an enzyme involved in codeine metabolism, not morphine.
D (Incorrect): Glucuronic acid is part of the conjugation process, not the active metabolite.

Question 55

A patient receiving morphine reports twitching and restlessness. The nurse understands this may be due to which of the following?
A. Morphine-6-glucuronide accumulation
B. Morphine-3-glucuronide neuroexcitatory effects
C. An allergic reaction to morphine
D. Rapid opioid tolerance development

Answer 55

Answer: B. Morphine-3-glucuronide neuroexcitatory effects
Rationale:

B (Correct): Morphine-3-glucuronide is a metabolite of morphine that has no pain-relieving effects but can cause neuroexcitatory symptoms like twitching, restlessness, and even seizures at high levels.
A (Incorrect): Morphine-6-glucuronide causes pain relief and respiratory depression, not neuroexcitatory effects.
C (Incorrect): Allergic reactions would present with symptoms like rash, itching, or difficulty breathing, not twitching.
D (Incorrect): Opioid tolerance involves reduced pain relief over time, not neuroexcitatory symptoms.

Question 56

Which patient is at the highest risk for morphine toxicity due to the accumulation of its active metabolites?
A. A patient with liver failure
B. A patient with chronic kidney disease
C. A patient with a history of opioid tolerance
D. A patient recovering from surgery

Answer 56

Answer: B. A patient with chronic kidney disease
Rationale:

B (Correct): Morphine metabolites, especially morphine-6-glucuronide, are excreted in the urine. Patients with chronic kidney disease cannot eliminate these metabolites effectively, increasing the risk of toxicity (e.g., respiratory depression).
A (Incorrect): Liver failure may slow the initial metabolism of morphine, but kidney function primarily affects metabolite clearance.
C (Incorrect): Opioid-tolerant patients may require higher doses for pain relief, but this does not directly increase metabolite accumulation.
D (Incorrect): Post-surgical patients may receive morphine, but without kidney dysfunction, metabolite accumulation is less likely.

Question 57

The nurse is teaching a group of students about morphine’s mechanism of action. Which of the following correctly describes how morphine relieves pain? (Select all that apply)
A. Binds to mu receptors in the central nervous system (CNS)
B. Mimics the actions of the body’s natural opioid peptides
C. Reduces inflammation at the site of injury
D. Acts in the CNS and peripheral nervous system
E. Directly blocks transmission of pain signals in the spinal cord

Answer 57

Answers: A, B, D
Rationale:

A (Correct): Morphine binds to mu receptors in the CNS, which reduces the perception of pain.
B (Correct): Morphine mimics the actions of endogenous opioid peptides, the body’s natural painkillers.
C (Incorrect): Morphine does not reduce inflammation; it works centrally to alter pain perception.
D (Correct): Morphine acts in both the CNS and peripheral nervous system to relieve pain.
E (Incorrect): Morphine does not directly block pain signal transmission; it modifies how pain is perceived in the brain.

Question 58

A nurse is caring for a patient who has been prescribed Percocet for postoperative pain. Which of the following components in Percocet provides pain relief?
A. Naloxone
B. Acetaminophen and Oxycodone
C. Oxymorphone
D. Noroxycodone

Answer 58

Answer: B. Acetaminophen and Oxycodone
Rationale:

B (Correct): Percocet contains oxycodone (opioid) and acetaminophen (non-opioid), both of which provide pain relief.
A (Incorrect): Naloxone is added to formulations like Targin to block opioid effects in the gut and reduce constipation, not for pain relief.
C (Incorrect): Oxymorphone is an active metabolite of oxycodone but is not present in Percocet directly.
D (Incorrect): Noroxycodone is an inactive metabolite and does not contribute to pain relief.

Question 59

The nurse is educating a patient taking oxycodone who also has a prescription for fluconazole. What is the nurse’s priority teaching point?
A. “You may need to increase your oxycodone dose while taking fluconazole.”
B. “Fluconazole may cause oxycodone to accumulate in your body, increasing the risk of toxicity.”
C. “Fluconazole will prevent oxycodone from being converted to its active form.”
D. “You should stop taking oxycodone while using fluconazole.”

Answer 59

Answer: B. “Fluconazole may cause oxycodone to accumulate in your body, increasing the risk of toxicity.”
Rationale:

B (Correct): Fluconazole is a moderate CYP3A4 inhibitor, which slows down oxycodone metabolism, leading to its accumulation and increasing the risk of toxicity (e.g., respiratory depression).
A (Incorrect): The dose does not need to be increased; the risk is accumulation, not decreased effectiveness.
C (Incorrect): Fluconazole affects CYP3A4, not CYP2D6, so it does not interfere with the conversion of oxycodone to oxymorphone.
D (Incorrect): Stopping oxycodone abruptly without a provider’s instruction can worsen pain or cause withdrawal symptoms.

Question 60

A patient is prescribed oxycodone for moderate pain and is also taking paroxetine. What should the nurse monitor for closely?
A. Increased sedation and signs of oxycodone toxicity
B. Signs of opioid withdrawal
C. Decreased pain relief from oxycodone
D. Increased gastrointestinal side effects

Answer 60

Answer: A. Increased sedation and signs of oxycodone toxicity
Rationale:

A (Correct): Paroxetine is a CYP2D6 inhibitor. It can slow the metabolism of oxycodone, leading to increased oxycodone levels and a higher risk of sedation and toxicity.
B (Incorrect): Opioid withdrawal occurs when opioids are stopped abruptly, not when levels are increased.
C (Incorrect): Paroxetine does not reduce pain relief; it increases oxycodone levels, potentially enhancing its effects.
D (Incorrect): Gastrointestinal effects like constipation are common with opioids but are unrelated to paroxetine.

Question 61

The nurse knows that oxycodone’s mechanism of action involves which of the following? (Select all that apply)
A. Binds to mu receptors in the CNS and periphery
B. Activates kappa receptors to block pain signals
C. Acts on delta receptors to provide analgesia
D. Directly reduces inflammation at the site of injury
E. Activates G-protein coupled receptor signaling pathways

Answer 61

Answers: A, B, C, E
Rationale:

A (Correct): Oxycodone binds to mu receptors to relieve pain.
B (Correct): Oxycodone also binds to kappa receptors, which contributes to its analgesic effects.
C (Correct): Delta receptors are another target for oxycodone, further enhancing pain relief.
D (Incorrect): Oxycodone does not reduce inflammation; it changes the perception of pain.
E (Correct): Oxycodone activates G-protein coupled receptor signaling pathways, which block pain signals.

Question 62

A nurse is reviewing the pharmacokinetics of oxycodone. Which of the following statements are correct? (Select all that apply)
A. Oxycodone is predominantly metabolized in the liver.
B. It is converted into oxymorphone, an active metabolite.
C. Noroxycodone is an active metabolite responsible for pain relief.
D. Oxycodone is primarily excreted through the urine.
E. Patients with poor CYP3A4 metabolism are at risk of oxycodone accumulation.

Answer 62

Answers: A, B, D, E
Rationale:

A (Correct): Oxycodone is primarily metabolized in the liver.
B (Correct): Oxycodone is converted into oxymorphone, which is an active metabolite with strong mu-opioid agonist activity.
C (Incorrect): Noroxycodone is an inactive metabolite and does not contribute to pain relief.
D (Correct): Oxycodone and its metabolites are excreted through the urine.
E (Correct): Poor metabolizers of CYP3A4 (e.g., due to drugs like fluconazole) can experience oxyocodone accumulation, increasing toxicity risk.

Question 63

Fentanyl is 100 times stronger than morphine and is commonly prescribed for which of the following?
A. Acute pain after surgery
B. Chronic pain or cancer pain in opioid-tolerant individuals
C. Mild to moderate pain
D. Pain associated with headaches

Answer 63

Answer: B. Chronic pain or cancer pain in opioid-tolerant individuals
Rationale:

B (Correct): Fentanyl is prescribed for chronic pain or cancer pain in patients who require constant analgesic effects and are already opioid-tolerant.
A (Incorrect): While fentanyl is a strong opioid, it is more commonly used for chronic pain management, not for acute pain.
C (Incorrect): Fentanyl is not typically used for mild to moderate pain.
D (Incorrect): Fentanyl is not typically prescribed for headache pain, as other treatments are more appropriate for this type of pain.

Question 64

Which of the following best describes the mechanism of action of fentanyl?
A. It stimulates dopamine receptors in the brain to block pain signals.
B. It stimulates the mu receptor in the CNS, altering the body’s response to pain.
C. It inhibits the breakdown of neurotransmitters in the brain.
D. It blocks pain signals at the spinal cord level.

Answer 64

Answer: B. It stimulates the mu receptor in the CNS, altering the body’s response to pain.
Rationale:

B (Correct): Fentanyl stimulates the mu receptor in the central nervous system (CNS), which changes the body’s response to pain and provides pain relief.
A (Incorrect): Fentanyl works on mu receptors, not dopamine receptors.
C (Incorrect): Fentanyl does not inhibit neurotransmitter breakdown; it works by binding to opioid receptors.
D (Incorrect): Fentanyl does not block pain signals at the spinal cord level; it works centrally in the brain and spinal cord.

Question 65

Fentanyl is known for its high potency and lipid solubility. What is the benefit of these properties?
A. It allows fentanyl to be absorbed through the transdermal route effectively.
B. It increases the risk of toxicity when used intravenously.
C. It prevents the accumulation of the drug in body tissues.
D. It reduces the need for continuous monitoring of blood levels.

Answer 65

Answer: A. It allows fentanyl to be absorbed through the transdermal route effectively.
Rationale:

A (Correct): The high potency and lipid solubility of fentanyl allow it to be effectively absorbed through the transdermal patch, providing a steady release of the drug over time.
B (Incorrect): While fentanyl is potent, its lipid solubility is beneficial for transdermal use, not for increasing toxicity when given intravenously.
C (Incorrect): High potency and lipid solubility do not prevent accumulation of fentanyl in body tissues; they mainly affect absorption and effectiveness.
D (Incorrect): Continuous monitoring of blood levels is still needed, especially in patients on high doses or long-term use.

Question 66

Which of the following is an important consideration for patients using fentanyl transdermal patches?
A. Patients should avoid heat exposure to the patch, as it may cause accelerated release.
B. Patients should apply a new patch to the same site every day to ensure effective drug delivery.
C. The patch should be worn for a maximum of 12 hours per day.
D. Patients are encouraged to return the patch to the pharmacy for disposal after each use.

Answer 66

Answer: A. Patients should avoid heat exposure to the patch, as it may cause accelerated release.
Rationale:

A (Correct): Heat can accelerate the release of fentanyl from the patch, increasing the risk of toxicity.
B (Incorrect): Patches are typically replaced every 72 hours, not daily, and should not be applied to the same site immediately.
C (Incorrect): Fentanyl patches are meant to be worn for 72 hours (3 days), not 12 hours.
D (Incorrect): Patients should return used patches to the pharmacy for proper disposal to avoid accidental exposure, but this is not related to the patch’s use during therapy.

Question 67

Fentanyl is metabolized by the CYP3A4 enzyme. What is the nurse’s priority when a patient is taking fentanyl along with a CYP3A4 inhibitor (e.g., fluconazole)?
A. Decrease the dose of fentanyl to prevent increased sedation.
B. Monitor for signs of opioid toxicity, as the inhibitor can increase fentanyl levels.
C. Instruct the patient to stop taking the CYP3A4 inhibitor immediately.
D. Observe the patient for withdrawal symptoms due to drug interaction.

Answer 67

Answer: B. Monitor for signs of opioid toxicity, as the inhibitor can increase fentanyl levels.
Rationale:

B (Correct): CYP3A4 inhibitors (e.g., fluconazole) can increase fentanyl levels, leading to a higher risk of opioid toxicity, such as sedation, respiratory depression, or overdose.
A (Incorrect): The dose of fentanyl should not be decreased without consulting the provider; monitoring is key.
C (Incorrect): Stopping the CYP3A4 inhibitor is not recommended without a healthcare provider’s guidance, as it may have other important roles.
D (Incorrect): Withdrawal symptoms are more likely if fentanyl is suddenly discontinued, not when taking it with a CYP3A4 inhibitor.

Question 68

A nurse is caring for a patient who has been prescribed Meperidine (Demerol) for pain management. The nurse is aware that Meperidine has which of the following characteristics?
A. Long half-life, requiring fewer doses for effective pain relief
B. No risk of toxic metabolite buildup
C. Short half-life, requiring multiple doses for continued pain relief
D. Ideal for long-term pain management due to its accumulation of metabolites

Answer 68

Answer: C. Short half-life, requiring multiple doses for continued pain relief
Rationale:

C (Correct): Meperidine (Demerol) has a short half-life, so it requires multiple doses to maintain pain relief.
A (Incorrect): Meperidine has a short half-life, not a long one, so it needs to be given more frequently.
B (Incorrect): Meperidine has a risk of toxic metabolite buildup, especially with long-term use.
D (Incorrect): Meperidine is not ideal for long-term pain management due to the risk of toxic metabolite accumulation.

Question 69

A patient is being treated with Meperidine (Demerol) for pain and is also prescribed a monoamine oxidase inhibitor (MAOI) for depression. What should the nurse monitor for in this patient?
A. Increased risk of serotonin toxicity, including excitation, delirium, convulsions, coma, or death
B. Increased sedation and respiratory depression
C. Reduced effectiveness of Meperidine (Demerol)
D. Decreased likelihood of developing drug tolerance

Answer 69

Answer: A. Increased risk of serotonin toxicity, including excitation, delirium, convulsions, coma, or death
Rationale:

A (Correct): Meperidine inhibits serotonin reuptake, and when combined with MAOIs, it can lead to serotonin toxicity, which causes symptoms such as excitation, delirium, convulsions, and even coma or death.
B (Incorrect): This is more typical of opioids like morphine or fentanyl, but Meperidine does not primarily cause respiratory depression or sedation with MAOI use.
C (Incorrect): Meperidine remains effective in pain relief, but the toxic effects are a concern with MAOI use, not its efficacy.
D (Incorrect): Drug tolerance is not directly affected by the interaction between Meperidine and MAOIs.

Question 70

A patient has been prescribed Meperidine (Demerol) for postoperative pain relief. The nurse is aware that Meperidine is now primarily used in which setting?
A. For chronic, long-term pain management
B. In the PACU to treat shivering after anesthesia
C. For severe pain management in patients with cancer
D. As a first-line treatment for acute pain

Answer 70

Answer: B. In the PACU to treat shivering after anesthesia
Rationale:

B (Correct): Meperidine is now mainly used in the PACU (Post-Anesthesia Care Unit) to treat shivering after anesthesia, as it has limited use for chronic or severe pain management.
A (Incorrect): Meperidine is not recommended for long-term pain management due to the risk of toxic metabolite accumulation.
C (Incorrect): Meperidine was previously used for severe pain, but it is no longer a first-line option for chronic pain, especially cancer pain.
D (Incorrect): Meperidine is no longer the first-line treatment for acute pain management due to its risks and availability of safer alternatives.

Question 71

A nurse is caring for a patient who has been on Meperidine (Demerol) for several days for postoperative pain. Which of the following is an important consideration related to its toxic metabolite?
A. Risk of serotonin toxicity from accumulation, especially with long-term use
B. Risk of tolerance developing quickly with prolonged use
C. Minimal risk of side effects with short-term use
D. No risk of harmful effects from the metabolite if the dose is adjusted

Answer 71

Answer: A. Risk of serotonin toxicity from accumulation, especially with long-term use
Rationale:

A (Correct): Meperidine has a toxic metabolite, and its accumulation can lead to serotonin toxicity, especially with long-term use. This can result in excitation, delirium, convulsions, and even death.
B (Incorrect): Tolerance to Meperidine can develop, but this is not the main concern related to its toxic metabolites.
C (Incorrect): Short-term use still poses the risk of toxic metabolite buildup, especially if it is used for more than a few days.
D (Incorrect): Adjusting the dose of Meperidine does not eliminate the risk of serotonin toxicity from the accumulation of its metabolites.

Question 72

A nurse is preparing to administer Meperidine (Demerol) to a patient for post-surgical pain. Which of the following should the nurse avoid in this patient?
A. Giving the patient meperidine with a CYP3A4 inhibitor
B. Administering the medication on a set schedule
C. Giving the patient acetaminophen for mild pain relief
D. Administering meperidine for a short duration for pain relief

Answer 72

Answer: A. Giving the patient meperidine with a CYP3A4 inhibitor
Rationale:

A (Correct): CYP3A4 inhibitors can slow down the metabolism of Meperidine, causing a buildup of toxic metabolites, leading to serotonin toxicity and other serious adverse effects.
B (Incorrect): Administering meperidine on a set schedule for short-term use is an appropriate method for ensuring pain relief.
C (Incorrect): Acetaminophen can be used for mild pain alongside Meperidine if needed.
D (Incorrect): Meperidine can be used for short-term pain relief, but care should be taken to avoid long-term use due to the toxic metabolite buildup.

Question 73

Methadone is used to treat which of the following conditions?
A. Acute pain only
B. Pain and opioid addiction
C. Chronic non-cancer pain
D. Heart failure

Answer 73

Answer: B. Pain and opioid addiction
Rationale:

B (Correct): Methadone is used to treat both pain and opioid addiction (e.g., in opioid replacement therapy).
A (Incorrect): Methadone is not typically used only for acute pain; it is more commonly used for chronic pain and addiction treatment.
C (Incorrect): While methadone is used for chronic pain, it is not exclusively used for non-cancer pain.
D (Incorrect): Methadone is not used to treat heart failure.

Question 74

Which of the following is an important consideration when prescribing methadone for a patient?
A. Methadone has a short duration of action, requiring frequent dosing.
B. Methadone has cardiac risk factors that can affect the heart’s electrical conduction.
C. Methadone has no effect on heart rhythm and is safe in all patients.
D. An ECG is only required if the patient has a history of cardiovascular disease.

Answer 74

Answer: B. Methadone has cardiac risk factors that can affect the heart’s electrical conduction.
Rationale:

B (Correct): Methadone can cause irregular heart rhythms due to its cardiac risk factors, and requires monitoring of heart function.
A (Incorrect): Methadone has a long duration of action, not a short one.
C (Incorrect): Methadone does affect heart rhythm and can cause cardiac arrhythmias, so caution is needed.
D (Incorrect): An ECG should be obtained prior to starting methadone and monitored regularly (30 days and annually), even for patients without a cardiovascular history.

Question 75

Prior to initiating methadone therapy, what must be done to ensure the patient’s safety?
A. Obtain an initial ECG and follow-up ECGs at 30 days and annually
B. Ensure the patient has no previous history of opioid use
C. Monitor liver function only before initiation
D. Discontinue any other pain medications

Answer 75

Answer: A. Obtain an initial ECG and follow-up ECGs at 30 days and annually
Rationale:

A (Correct): It is important to obtain an initial ECG to assess heart function before starting methadone. Follow-up ECGs are required at 30 days and then annually to monitor for potential cardiac risks.
B (Incorrect): There is no requirement for a history of opioid use before initiating methadone. It is often prescribed for opioid addiction.
C (Incorrect): Liver function is important to monitor with some drugs, but cardiac monitoring is the priority with methadone.
D (Incorrect): Discontinuing other pain medications is not necessarily required; methadone is often used in combination with other treatments for addiction.

Question 76

What potential side effect of methadone requires careful monitoring, especially with long-term use?
A. Respiratory depression and irregular heart rhythms
B. Increased appetite
C. Constipation and urinary retention
D. Hypoglycemia

Answer 76

Answer: A. Respiratory depression and irregular heart rhythms
Rationale:

A (Correct): Methadone can cause respiratory depression and irregular heart rhythms, which requires careful monitoring, especially for patients on long-term therapy.
B (Incorrect): While methadone may cause side effects like constipation, increased appetite is not a significant concern.
C (Incorrect): Constipation is a common side effect of opioids in general, but urinary retention and constipation are not the main concerns for methadone specifically.
D (Incorrect): Hypoglycemia is not typically associated with methadone use.

Question 77

A nurse is educating a patient who will begin methadone therapy. What is the nurse’s priority teaching point?
A. “Methadone is safe to take with any other pain medications.”
B. “You may experience irregular heart rhythms, so we will monitor your heart function regularly.”
C. “Methadone can be stopped abruptly once pain is under control.”
D. “You should avoid taking methadone for more than one month.”

Answer 77

Answer: B. “You may experience irregular heart rhythms, so we will monitor your heart function regularly.”
Rationale:

B (Correct): One of the primary risks of methadone is cardiac risk, particularly irregular heart rhythms, which require regular heart function monitoring (ECGs).
A (Incorrect): Methadone should not be combined with other medications without careful consideration due to drug interactions and risks of respiratory depression.
C (Incorrect): Methadone should not be stopped abruptly; discontinuation requires gradual tapering under medical supervision to avoid withdrawal symptoms.
D (Incorrect): Methadone can be used long-term for opioid addiction or pain management, and the duration depends on the patient’s needs.