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A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition?
- A. Tachycardia
- B. Central nervous system depression
- C. Hepatic necrosis
- D. Nephropathy
Correct Answer: C
Rationale: Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen. The other options are incorrect.
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A 16-year-old field hockey player fell and twisted her ankle during a game. The nurse will expect to administer which type of analgesic?
- A. Synthetic opioid, such as meperidine
- B. Opium alkaloid, such as morphine sulfate
- C. Opioid antagonist, such as naloxone HCL
- D. Nonopioid analgesics, such as indomethacin
Correct Answer: D
Rationale: Somatic pain, which originates from skeletal muscles, ligaments, and joints, usually responds to nonopioid analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs). The other options are not the best choices for somatic pain.
A patient arrives at the urgent care center complaining of leg pain after a fall when rock climbing. The radiographs show no broken bones, but he has a large bruise on his thigh. The patient says he drives a truck and does not want to take anything strong because he needs to stay awake. Which statement by the nurse is most appropriate?
- A. It would be best for you not to take anything if you are planning to drive your truck.
- B. We will discuss with your doctor about taking an opioid because that would work best for your pain.
- C. You can take acetaminophen, also known as Tylenol, for pain, but no more than 1000 mg per day.
- D. You can take acetaminophen, also known as Tylenol, for pain, but no more than 3000 mg/day.
Correct Answer: D
Rationale: Acetaminophen is indicated for mild-to-moderate pain and does not cause drowsiness, as an opioid would. Currently, the maximum daily amount of acetaminophen is 3000 mg/day. The 1000 mg amount per day is too low. Telling the patient not to take any pain medications is incorrect.
A 57-year-old woman being treated for end-stage breast cancer has been using a transdermal opioid analgesic as part of the management of pain. Lately, she has been experiencing breakthrough pain. The nurse expects this type of pain to be managed by which of these interventions?
- A. Administering NSAIDs
- B. Administering an immediate-release opioid
- C. Changing the opioid route to the rectal route
- D. Making no changes to the current therapy
Correct Answer: B
Rationale: If a patient is taking long-acting opioid analgesics, breakthrough pain must be treated with an immediate-release dosage form that is given between scheduled doses of the long-acting opioid. The other options are not appropriate actions.
The nurse is assessing a patient who has been admitted to the emergency department for a possible opioid overdose. Which assessment finding is characteristic of an opioid drug overdose?
- A. Dilated pupils
- B. Restlessness
- C. Respiration rate of 6 breaths/min
- D. Heart rate of 55 beats/min
Correct Answer: C
Rationale: The most serious adverse effect of opioid use is CNS depression, which may lead to respiratory depression. Pinpoint pupils, not dilated pupils, are seen. Restlessness and a heart rate of 55 beats/min are not indications of an opioid overdose.
The opioid Vicodin (acetaminophen/hydrocodone) is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication?
- A. Diarrhea
- B. Constipation
- C. Lightheadedness
- D. Nervousness
- E. Urinary retention
- F. Itching
Correct Answer: B,C,E,F
Rationale: Constipation (not diarrhea), lightheadedness (not nervousness), urinary retention, and itching are some of the common adverse effects that the patient may experience while taking opioids such as Vicodin.