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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.
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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.
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).
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.
The nurse is reviewing herbal therapies. Which is a common use of the herb feverfew?
- A. Muscle aches
- B. Menstrual cramps
- C. Joint pain
- D. Incision pain after surgery
Correct Answer: B
Rationale: Feverfew is commonly used for migraine headaches, menstrual problems, arthritis, and fever. Possible adverse effects include muscle stiffness and muscle and joint pain.
The drug nalbuphine is an agonist-antagonist (partial agonist). The nurse understands that which is a characteristic of partial agonists?
- A. They have anti-inflammatory effects.
- B. They are given to reverse the effects of opiates.
- C. They have a higher potency than agonists.
- D. They have a lower dependency potential than agonists.
Correct Answer: D
Rationale: Partial agonists such as nalbuphine are similar to the opioid agonists in terms of their therapeutic indications; however, they have a lower risk of misuse and addiction. They do not have anti-inflammatory effects, nor are they given to reverse the effects of opiates. They do not have a higher potency than agonists.