Question 1

A nurse is preparing a pediatric patient for surgery and is teaching the patient and the child's parents about the use of the patient-controlled analgesia pump. The parents voice concern about their child receiving an overdose of morphine. What will the nurse do?

Accepted Answer

A)   Instruct the parents not to activate the device when their child is sleeping.
B)   Reassure the parents that drug overdose is not possible with PCA.
C)   Suggest that the child use the PCA sparingly.
D)   Tell the patient that the pump can be programmed for PRN dosing only. A

Question 2

A woman in labor receives meperidine [Demerol] for pain. The nurse caring for the infant will observe the infant closely for:

Accepted Answer

A)   congenital anomalies.
B)   excessive crying and sneezing.
C)   respiratory depression.
D)   tremors and hyperreflexia. C

Question 3

A patient asks the nurse what can be given to alleviate severe, chronic pain of several months' duration. The patient has been taking oxycodone [OxyContin] and states that it is no longer effective. The nurse will suggest discussing which medication with the provider?

Accepted Answer

A)   Fentanyl [Duragesic] transdermal patch
B)   Hydrocodone [Vicodin] PO
C)   Meperidine [Demerol] PO
D)   Pentazocine [Talwin] PO A

Question 4

A patient is brought to the emergency department by friends, who report finding the patient difficult to awaken. The friends report removing two fentanyl transdermal patches from the patient's arm. On admission to the emergency department, the patient has pinpoint pupils and a respiratory rate of 6 breaths per minute. A few minutes after administration of naloxone, the respiratory rate is 8 breaths per minute and the patient's pupils are dilated. The nurse recognizes these symptoms as signs of:

Accepted Answer

A)   a mild opioid overdose.
B)   decreased opioid drug levels.
C)   improved ventilation.
D)   worsening hypoxia.

Question 5

A patient will receive buprenorphine [Butrans] as a transdermal patch for pain. What is important to teach this patient about the use of this drug?

Accepted Answer

A)   Avoid prolonged exposure to the sun.
B)   Cleanse the site with soap or alcohol.
C)   Remove the patch daily at bedtime.
D)   Remove hair by shaving before applying the patch.

Question 6

A patient who has developed opioid tolerance will experience which effect?

Accepted Answer

A)   Decreased analgesic effect
B)   Decreased constipation
C)   Increased euphoria
D)   Increased respiratory depression

Question 7

Which side effects of opioid analgesics can have therapeutic benefits?

Accepted Answer

A)   Biliary colic
B)   Cough suppression
C)   Suppression of bowel motility
D)   Urinary retention
E)   Vasodilation

Question 8

A patient who has biliary colic reports a pain level of 8 on a 1 to 10 pain scale with 10 being the most severe pain. The patient has an order for ibuprofen as needed for pain. Which action by the nurse is correct?

Accepted Answer

A)   Administer the ibuprofen as ordered.
B)   Contact the provider to discuss nonpharmacologic pain measures.
C)   Request an order for meperidine [Demerol].
D)   Request an order for morphine sulfate.

Question 9

A patient with cancer has been taking an opioid analgesic 4 times daily for several months and reports needing increased doses for pain. What will the nurse tell the patient?

Accepted Answer

A)   PRN dosing of the drug may be more effective.
B)   The risk of respiratory depression increases over time.
C)   The patient should discuss increasing the dose with the provider.
D)   The patient should request the addition of a benzodiazepine to augment pain relief.

Question 10

A patient with moderate to severe chronic pain has been taking oxycodone [OxyContin] 60 mg every 6 hours PRN for several months and tells the nurse that the medication is not as effective as before. The patient asks if something stronger can be taken. The nurse will contact the provider to discuss:

Accepted Answer

A)   administering a combination opioid analgesic/acetaminophen preparation.
B)   changing the medication to a continued-release preparation.
C)   confronting the patient about drug-seeking behaviors.
D)   withdrawing the medication, because physical dependence has occurred.

Question 11

A patient with chronic pain has been receiving morphine sulfate but now has decreased pain. The prescriber changes the medication to pentazocine [Talwin]. The nurse will monitor the patient for:

Accepted Answer

A)   euphoria.
B)   hypotension.
C)   respiratory depression.
D)   yawning and sweating.

Question 12

A patient has been taking methadone [Dolophine] for 5 months to overcome an opioid addiction. The nurse should monitor the patient for which of the following electrocardiographic changes?

Accepted Answer

A)   Prolonged QT interval
B)   Prolonged P-R interval
C)   AV block
D)   An elevated QRS complex

Question 13

A nurse is administering morphine sulfate to a postoperative patient. Which are appropriate routine nursing actions when giving this drug?

Accepted Answer

A)   Counting respirations before and after giving the medication
B)   Encouraging physical activity and offering increased fluids
C)   Monitoring the patient's blood pressure closely for hypertension
D)   Palpating the patient's lower abdomen every 4 to 6 hours
E)   Requesting an order for methylnaltrexone [Relistor] to prevent constipation

Question 14

A patient who has had abdominal surgery has been receiving morphine sulfate via a patient-controlled analgesia (PCA) pump. The nurse assesses the patient and notes that the patient's pupils are dilated and that the patient is drowsy and lethargic. The patient's heart rate is 84 beats/min, the respiratory rate is 10 breaths per minute, and the blood pressure is 90/50 mm Hg. What will the nurse do?

Accepted Answer

A)   Discuss possible opiate dependence with the patient's provider.
B)   Encourage the patient to turn over and cough and take deep breaths.
C)   Note the effectiveness of the analgesia in the patient's chart.
D)   Prepare to administer naloxone and possibly ventilatory support.

Exam 28: Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics