Chapter 26: Nonopioid and Opioid Analgesics Nursing School Test Banks

Chapter 26: Nonopioid and Opioid Analgesics
Test Bank

MULTIPLE CHOICE

1. The nurse is evaluating a patient 2 hours after giving a dose of 30 mg of codeine with acetaminophen for postoperative pain after abdominal surgery. The patient reports a pain level of 7 on a scale of 1 to 10. The nurse notes a heart rate of 110 beats per minute, a respiratory rate of 28 breaths per minute, and a blood pressure of 180/90 mm Hg. Which action will the nurse take?
a. Administer the next dose of codeine one hour early.
b. Ask the provider if the codeine dose can be increased.
c. Contact the provider to ask if a dose of ibuprofen may be given now.
d. Request an order for oxycodone with acetaminophen (Percocet).
ANS: D
The patient is showing signs of moderate to severe pain unrelieved by codeine, so the nurse should request a more potent opioid analgesic such as oxycodone. Codeine is effective for mild to moderate pain so will not be effective for this patient even if the dose is increased. The medication should not be given more frequently than every 4 hours. Ibuprofen is used for musculoskeletal pain and not postoperative pain.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 361
TOP: NURSING PROCESS: Evaluation/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. The nurse is teaching a female patient who will begin taking 2 tablets of 325 mg acetaminophen every 4 to 6 hours as needed for pain. Which statement by the patient indicates understanding of the teaching?
a. I may take acetaminophen up to 6 times daily if needed.
b. I should increase the dose of acetaminophen if I drink caffeinated coffee.
c. If I take oral contraceptive pills, I should use back-up contraception.
d. It is safe to take acetaminophen with any over-the-counter medications.
ANS: A
The maximum daily dose of acetaminophen is 4000 mg. If this patient takes 650 mg/dose 6 times daily, this amount is safe. Taking acetaminophen with caffeine increases the effect of the acetaminophen. Taking acetaminophen with OCPs decreases the effect of the acetaminophen but does not diminish the effect of the OCP. Many over-the-counter medications contain acetaminophen, so patients should be advised to read labels carefully to avoid overdose.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 355
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. The parent of a 5-year-old child asks the nurse to recommend an over-the-counter pain medication for the child. Which analgesic will the nurse recommend?
a. Acetaminophen (Tylenol)
b. Aspirin (Ecotrin)
c. Diflunisal (Dolobid)
d. Ibuprofen (Motrin)
ANS: A
Acetaminophen is safe to give children and does not cause gastrointestinal upset or interfere with platelet aggregation. Aspirin carries an increased risk of Reyes syndrome in children. Diflunisal (Dolobid) is not available over the counter.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 355
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. The nurse is performing an admission assessment on an adolescent who reports taking extra-strength acetaminophen (Tylenol) regularly to treat daily headaches. The nurse will notify the patients provider and discuss an order for
a. a selective serotonin receptor agonist (SSRA).
b. hydrocodone with acetaminophen for headache pain.
c. liver enzyme tests.
d. serum glucose testing.
ANS: C
Large doses or overdoses of acetaminophen can be toxic to hepatic cells, so when large doses are administered over a long period, liver function should be assessed. Daily headaches are not typical of migraine headaches, so SSRA medication is not indicated. Hydrocodone with acetaminophen is not indicated without further evaluation of headaches. Serum glucose is not indicated.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 355
TOP: NURSING PROCESS: Assessment/Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The nurse is caring for a postoperative older patient who received PO hydrocodone with acetaminophen (Lortab) 45 minutes prior after reporting a pain level of 8 on a scale of 1 to 10. The patient reports a pain level of 4, and the nurse notes a respiratory rate of 20 breaths per minute, a heart rate of 92 beats per minute, and a blood pressure of 170/95 mm Hg. Which action will the nurse take?
a. Contact the provider and request an order for a more potent opioid analgesic.
b. Reassess the patient in 30 minutes.
c. Request an order for ibuprofen to augment the opioid analgesic.
d. Suggest that the patient use nonpharmacologic measures to relieve pain.
ANS: A
Even though the patient reports decreased pain, the patients vital signs indicate continued discomfort. The nurse should contact the provider to request a stronger analgesic. The pain medication should have been effective within 30 minutes. Ibuprofen is used for musculoskeletal pain. Nonpharmacologic measures may be useful, but the patient still needs a stronger analgesic.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 355
TOP: NURSING PROCESS: Nursing Intervention/Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. The nurse is providing teaching to a patient who will begin taking aspirin to treat arthritis pain. Which statement by the patient indicates a need for further teaching?
a. I should increase fiber and fluids while taking aspirin.
b. I will call my provider if I have abdominal pain.
c. I will drink a full glass of water with each dose.
d. I will notify my provider of ringing in my ears.
ANS: A
Aspirin is not constipating, so patients do not need to be counseled to consume extra fluids and fiber. Abdominal pain can occur with gastrointestinal bleeding, and tinnitus (ringing in the ears) can be an early sign of toxicity, so patients should be taught to contact their provider if these occur. Taking a full glass of water with each dose helps minimize gastrointestinal side effects.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 355
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. An adolescent female has dysmenorrhea associated with heavy menstrual periods. The patients provider has recommended ibuprofen (Motrin). When teaching this patient about this drug, the nurse will tell her that ibuprofen
a. may decrease the effectiveness of oral contraceptive pills.
b. may increase bleeding during her period.
c. should be taken on an empty stomach to increase absorption.
d. will decrease the duration of her periods.
ANS: B
When nonsteroidal antiinflammatory drugs (NSAIDs) are used to treat dysmenorrhea, excess bleeding may occur during the first 2 days of a period. NSAIDs do not decrease the effect of OCPs. NSAIDs are irritating to the stomach, so patients should take with food or a full glass of water. NSAIDs will not decrease the duration of periods.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 355
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The emergency department nurse is caring for a patient who has received morphine sulfate for severe pain following an injury. The nurse performs a drug history and learns that the patient takes St. Johns wort for symptoms of depression. The nurse will observe this patient closely for an increase in which opioid adverse effect?
a. Constipation
b. Pruritis
c. Respiratory depression
d. Sedation
ANS: D
St. Johns wort can increase the sedative effects of opioids. It does not enhance other side effects.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 358
TOP: NURSING PROCESS: Planning/Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. The nurse is performing an admission assessment on a stable patient admitted after a motor vehicle accident. The patient reports having bad pain. What will the nurse do first?
a. Administer acetaminophen (Tylenol).
b. Ask the patient to rate the pain on a 1 to 10 scale.
c. Attempt to determine what type of pain the patient has.
d. Request an order for an intravenous opioid analgesic.
ANS: B
To ascertain severity of pain, the nurse should ask the patient to rate the pain on a scale of 1 to 10. Further assessments include location and type of pain. Pain medication should be given after the severity of pain is assessed so that an appropriate analgesic may be given.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 353
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. The nurse assumes care of a patient in the post-anesthesia care unit (PACU). The patient had abdominal surgery and is receiving intravenous morphine sulfate for pain. The patient is asleep and has not voided since prior to surgery. The nurse assesses a respiratory rate of 10 breaths per minute and notes hypoactive bowel sounds. The nurse will contact the surgeon to report which condition?
a. Paralytic ileus
b. Respiratory depression
c. Somnolence
d. Urinary retention
ANS: B
The patients respiratory rate of 10 breaths per minute is lower than normal and is a sign of respiratory depression, which is a common adverse effect of opioid analgesics. The other effects may occur with opioids but are also not expected this soon after abdominal surgery.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 354
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. One hour after receiving intravenous morphine sulfate, a patient reports generalized itching. The nurse assesses the patient and notes clear breath sounds, no rash, respirations of 14 breaths per minute, a heart rate of 68 beats per minute, and a blood pressure of 110/70 mm Hg. Which action will the nurse take?
a. Administer naloxone to reverse opiate overdose.
b. Have resuscitation equipment available at the bedside.
c. Prepare an epinephrine injection in case of an anaphylactic reaction.
d. Reassure the patient that this is a common side effect of this drug.
ANS: D
Pruritis is a common opioid side effect and can be managed with diphenhydramine. Patients developing anaphylaxis will have urticaria and hypotension, and these patients will need epinephrine and resuscitation. Respiratory depression is a sign of morphine overdose, which will require naloxone.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 359
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. The nurse administers nalbuphine (Nubain) to a patient who is experiencing severe pain. Which statement by the patient indicates a need for further teaching about this drug?
a. I may experience unusual dreams while taking this medication.
b. I may need to use a laxative when taking this drug.
c. I should ask for assistance when I get out of bed.
d. I should expect to have more frequent urination.
ANS: D
A common side effect of opioid agents is urinary retention. Patients should notify the nurse if they cannot void. Side effects may include unusual dreams, constipation, and dizziness.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 364
TOP: NURSING PROCESS: Planning/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

13. The nurse is caring for a patient who was admitted with a fractured leg and for observation of a closed head injury after a motor vehicle accident. The patient reports having pain at a level of 3 on a 1 to 10 pain scale. The nurse will expect the provider to order which analgesic medication for this patient?
a. Acetaminophen (Tylenol) PO
b. Hydromorphone HCl (Dilaudid) IM
c. Morphine sulfate PCA
d. Transdermal fentanyl (Duragesic)
ANS: A
Use of opioid analgesics is contraindicated for patients with head injuries because of the risk of increased intracranial pressure. If opioids are necessary because of severe pain, they must be given in reduced doses. This patient is experiencing mild pain, so acetaminophen is an appropriate analgesic.

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TOP: NURSING PROCESS: Planning/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. Which patient may require a higher than expected dose of an opioid analgesic?
a. A patient with cancer
b. A patient with a concussion
c. A patient with hypotension
d. A patient 3 days after surgery
ANS: A
Opioids are titrated for oncology patients until pain relief is achieved or the side effects become intolerable, and extremely high doses may be required. Patient with closed head injuries should receive reduced doses of opioids if at all to reduce the risk of increased intracranial pressure. Patients with hypotension should receive reduced doses to prevent further decrease in blood pressure. Patients who are 3 days post-operation should not be experiencing severe pain.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 360
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15. The nurse assesses an older patient 60 minutes after administering 4 mg of intravenous morphine sulfate (MS) for postoperative pain. The patients analgesia order is for 2 to 5 mg of MS IV every 2 hours. The nurse notes that the patient is lying very still. The patients heart rate is 96 beats per minute, respiratory rate is 14 breaths per minute, and blood pressure is 140/90 mm Hg. When asked to rate the level of pain, the patient replies just a 5. The nurse will perform which action?
a. Give 3 mg of MS at the next dose.
b. Give 5 mg of MS at the next dose.
c. Request an order for an oral opioid to give now.
d. Request an order for acetaminophen to give now.
ANS: B
Older patients often minimize pain when asked, so the nurse should evaluate nonverbal cues to pain such as elevated heart rate and blood pressure and the fact that the patient is lying very still. The nurse should increase the dose the next time the pain medication is given.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 363
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

16. A postoperative patient has a history of opioid abuse. Which analgesic medication will the nurse expect the provider to order for this patient?
a. Buprenorphine (Buprenex)
b. Butorphanol tartrate (Stadol)
c. Naloxone (Narcan)
d. Pentazocine (Talwin)
ANS: A
Buprenorphine is an opioid agonist-antagonist analgesic and was developed to help decrease opioid abuse. Butophanol and pentazocine are also in this class, but reports say that they cause dependence. Naloxone is an opioid antagonist and is given to reverse the effects of opioids if toxicity occurs.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 364
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

17. The nurse checks on a patient who has received sumatriptan (Imitrex) for treatment of a migraine headache. The patient reports moderate improvement in headache pain and reports feeling dizzy. The nurse notes a blood pressure of 160/85 mm Hg. Which action by the nurse is correct?
a. Notify the provider of the dizziness.
b. Notify the provider of the increased blood pressure.
c. Plan to administer a second dose in 1 hour.
d. Request an order for intranasal sumatriptan.
ANS: B
Triptans can cause increased blood pressure, which is an adverse drug reaction and should be reported to the provider. Dizziness is a common side effect but not potentially life-threatening. The second dose should not be given if the patient is experiencing elevated blood pressure. Intranasal sumatriptan has the same adverse effects.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 366
TOP: NURSING PROCESS: Nursing Intervention/Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

18. The nurse is caring for a 6-year-old child who had surgery that morning. The child is awake and lying very still in bed and wont respond when the nurse asks about pain. The nurse will perform which action?
a. Ask the child to rate the pain on a scale of 1 to 10.
b. Encourage the child to request pain medication when needed.
c. Evaluate the childs pain using an ouch scale.
d. Plan to administer pain medication if the child begins to cry.
ANS: C
Some children will not verbalize discomfort even when they have severe pain because they fear injections. Nurses may use an ouch scale or a faces scale to evaluate pain if the child wont respond. Waiting for severe pain is not appropriate.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 362
TOP: NURSING PROCESS: Assessment/Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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