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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.
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A patient had abdominal surgery this morning. The patient is groggy but complaining of severe pain around the incision. What is the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient?
- A. The patient's pulse rate
- B. The patient's respiratory rate
- C. The appearance of the incision
- D. The date of the patient's last bowel movement
Correct Answer: B
Rationale: One of the most serious adverse effects of opioids is respiratory depression. The nurse must assess the patient's respiratory rate before administering an opioid. The other options are incorrect.
A patient is to receive acetylcysteine as part of the treatment for an acetaminophen overdose. Which action by the nurse is appropriate when giving this medication?
- A. Giving the medication undiluted for full effect
- B. Avoiding the use of a straw when giving this medication
- C. Disguising the flavor with soda or flavored water
- D. Preparing to give this medication via a nebulizer
Correct Answer: C
Rationale: Acetylcysteine has the flavor of rotten eggs and so is better tolerated if it is diluted and disguised by mixing with a drink such as cola or flavored water to help increase its palatability. The use of a straw helps to minimize contact with the mucous membranes of the mouth and is recommended. The nebulizer form of this medication is used for certain types of pneumonia, not for acetaminophen overdose.
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.
A patient is to receive methadone 2.5 mg intramuscularly (IM) now. The medication is available in a concentration of 10 mg/mL. Identify how many milliliters of methadone will be drawn up for this dose.
Correct Answer: 0.25 mL
Rationale: 10 mg : 1 mL :: 2.5 mg : x mL; (10 * x) = (1 * 2.5); 10x = 2.5; x = 0.25 mL.
A patient with a history of chronic pain has been using an opioid analgesic for 4 months and reports that a larger dose of the pain medication is needed for the same pain relief. The nurse is aware that this patient is experiencing which of these?
- A. Opioid addiction
- B. Opioid tolerance
- C. Opioid toxicity
- D. Opioid abstinence syndrome
Correct Answer: B
Rationale: Opioid tolerance is a common physiologic result of long-term opioid use. Patients with opioid tolerance require larger doses of the opioid agent to maintain the same level of analgesia. This situation does not describe toxicity (overdose), addiction, or abstinence syndrome (withdrawal).