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The nurse is assessing a patient for contraindications to drug therapy with acetaminophen (Tylenol). Which patient should not receive acetaminophen?
- A. A patient with a fever of 101?°F (38.3?°C)
- B. A patient who is complaining of a mild headache
- C. A patient with a history of liver disease
- D. A patient with a history of peptic ulcer disease
Correct Answer: C
Rationale: Liver disease is a contraindication to the use of acetaminophen. Fever and mild headache are both possible indications for the medication. Having a history of peptic ulcer disease is not a contraindication.
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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 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.
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.
A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 7 breaths/minute. The nurse prepares for which priority action at this time?
- A. Assessment of the patient's pain level
- B. Immediate intubation and artificial ventilation
- C. Administration of naloxone (Narcan)
- D. Close observation of signs of opioid tolerance
Correct Answer: C
Rationale: Naloxone is an opioid antagonist used to reverse the effects of opioid overdose, such as respiratory depression. The patient's symptoms of lethargy and shallow respirations at 7 breaths/minute indicate a potential opioid overdose, making naloxone administration the priority action. The other options are not appropriate in this urgent situation.
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.