Question 1

What is the most important question to ask before administering the first dose of celecoxib (Celebrex)to a patient?

Accepted Answer

Celecoxib is similar to the class of antibiotics known as "sulfa drugs." An allergic reaction to celecoxib is more likely if the patient is also allergic to sulfa drugs.

Question 2

You are assigned to care for a patient with chronic low back pain.What adjustment in pain management do you expect to make?

Accepted Answer

Adaptation to the presence of chronic pain is physiologic,not psychologic.Thus the usual alterations in physiologic parameters when acute pain is present do not accompany chronic pain.

Question 3

You note all of the following changes in the last week in a 72-year-old nursing home patient taking nortriptyline (Pamelor)for chronic pain.For which problem do you immediately notify the prescriber?

Accepted Answer

Nortriptyline is an antidepressant.These drugs can make heat failure worse and can cause urinary retention.Fluid retention with weight gain is a symptom of worsening heart failure.A weight gain of 9 lb in a week is significant and an indicator of rapidly worsening heart failure.

Question 4

A patient taking warfarin (Coumadin)has mild to moderate pain after exercising.Which over-the-counter pain reliever should you recommend?

Accepted Answer

Only acetaminophen does not interfere with blood clotting.The other drugs do interfere with blood clotting,and so does warfarin.Taking warfarin with any other drug that interferes with blood clotting places the patient at extreme risk for excessive bleeding and brain hemorrhage.

Question 5

A patient is receiving morphine (MS Contin)for severe cancer pain.His wife states that he has difficulty swallowing and asks if the tablets can be crushed and given with applesauce or pudding.What is your best response?

Accepted Answer

MS Contin is an extended release tablet so crushing or dissolving it can cause a drug overdose from releasing too much drug at a time.The best action is to contact the prescriber with the information about the patient's difficulty swallowing because a different form or morphine or a different drug may be needed to control the pain.Teach patients and their families to take an extended release (ER)form of an oral opioid drug by swallowing the capsule or tablet whole because chewing it or opening the capsule allows too much of the drug to be absorbed all at once and an overdose can occur.

Question 6

A patient tells you that the usual dose of an opioid drug for cancer pain no longer relieves the pain.What is your best response?

Accepted Answer

An issue that can occur with longer-term opioid use is drug tolerance.Tolerance is the adjustment of the body to long-term opioid use that increases the rate of drug elimination and reduces the main effect (pain relief)and side effects of the drug.It occurs with anyone who is taking opioids for a long period of time.More drug is needed to achieve the same degree of pain relief.

Question 7

A patient is taking acetaminophen (Tylenol)for mild headache pain.Which precaution is most important for you to teach the patient?

Accepted Answer

Acetaminophen can cause severe liver damage and even liver failure when taken at high doses or too often.This adverse reaction is much more likely to occur in people who drink alcoholic beverages while on acetaminophen therapy.

Question 8

Which key point should you teach a pregnant woman who is prescribed opioids drugs during pregnancy?

Accepted Answer

Opioids may be prescribed to women during pregnancy.These drugs do cross the placenta and enter the fetus.The fetus can become addicted to opioids and go through withdrawal after birth.Opioids also cross into breast milk.

Question 9

You check a patient for pain relief 1 hour after administering 15 mg of morphine intramuscularly.The patient is sleeping and has a respiratory rate of 10 breaths/min.What is your best first action?

Accepted Answer

Many patients experience some degree of respiratory depression with opioid analgesics.If the patient can be aroused with minimally intrusive techniques and the respiratory rate increases spontaneously,no further intervention is required.

Question 10

After receiving the first dose of an opioid drug,a patient is sleeping and has a respiratory rate of less than 8 per minute.When called by name the patient does not respond.What is your next best action?

Accepted Answer

When the patient is receiving an opioid for the first time or when the drug dosage has been increased,if the respiratory rate is 8 or less and the patient is sleeping,try to wake him or her.First call the patient's name.If there is no response,gently shake his or her arm or leg.Shake more firmly if needed.If the patient does not respond to these actions,use a slightly stronger trigger (without using enough force to cause harm)such as squeezing the trapezius muscle (located at the angle of the shoulder and neck muscle)or applying pressure to the nail bed.

Question 11

What is the best way for you to determine a patient's need for pain medication on the second day after an abdominal laparotomy?

Accepted Answer

Pain experience and pain tolerance are very personal.True assessment of a patient's discomfort cannot be determined by and should not be based on the patient's behaviors or changes in vital signs.Nor can it be based on how recently the patient received a drug for pain.The only way to know is to ask the patient to rate the pain.

Question 12

You prepare to give a patient the next scheduled dose of an opioid analgesic.The patient arouses easily but the respiratory rate remains at 10 breaths/min.What is your best first action?

Accepted Answer

Many people experience mild respiratory depression with opioid analgesics.If the patient is easily arousable and the oxygen saturation is at normal levels,it is not necessary to apply oxygen,call the Rapid Response Team,or prepare to administer an opioid antagonist.If the patient's oxygen saturation level is acceptable and he or she is in pain,it is alright to give the next scheduled opioid dose.Checking the patient's normal respiratory rate is also a good idea.Most people have a usual respiratory rate that is at least 12 breaths/min,but some patients may have a usual rate of only 10 breaths/min.Although this is not a customary response and you should document it in the patient care notes,check other indicators of breathing adequacy before notifying the prescriber.

Question 13

An older adult is taking an oral opioid drug at home for pain control.Which precaution to prevent injury is important for you to teach this patient?

Accepted Answer

In addition to the usual side effects and adverse effect of opioids,an older adult is at risk for low vision.The pupil of the older adult does not dilate fully and less light enters the eye,reducing vision.When the older patient takes an opioid drug,the pupil is even smaller than usual,reducing vision even more.This problem increases the older patient's risk for tripping over objects and falling.

Question 14

For which opioid pain drug order should you contact and question the prescriber?

Accepted Answer

Opioids,especially meperidine (Demerol),can make the chest muscles of older adults tighter,which makes breathing and coughing more difficult.Thus the risk for pneumonia and hypoxia is greater for them.Check the respiratory rate and depth as well as the oxygen saturation at least every 2 hours.In addition,meperidine causes the buildup of a toxic metabolite in older adults that can result in seizures.Avoid the use of meperidine in older adults.

Question 15

A patient taking oxycodone with acetaminophen (Percocet)for pain at home 3 days after fracturing an ankle reports constipation and continuing moderate to severe pain that is relieved by the prescribed drug.What is your best advice?

Accepted Answer

This patient still needs the Percocet.Most patients taking opioids for 2 days or longer have constipation.Urge the patient to drink plenty of fluids.Increasing fiber intake,either with food containing fiber or with over-the-counter fiber supplements,can help reduce constipation.Although increasing activity can help reduce constipation,walking for 30 minutes with a fractured ankle is not permitted at this time.

Question 16

You are administering the first dose of an opioid drug to a patient.Which specific related actions should you take before and after giving the dose?

Accepted Answer

When giving the first dose of an opioid to a patient who has never taken an opioid (is opioid naïve),check the patient's respiratory rate and oxygen saturation.Opioids can cause some degree of respiratory depression.After giving the drug,be sure to monitor the patient's respiratory rate and oxygen saturation for indications of respiratory depression.This is especially important when the patient is receiving an opioid for the first time or when the drug dosage has been increased.

Question 17

The patient who received a first dose of an opioid drug is not arousable and has an oxygen saturation of 88% (five percentage points lower than his or her normal saturation)even when fully awake.What is your best next action?

Accepted Answer

If the patient cannot be aroused,immediately call for help.If the patient's oxygen saturation is below 95% or is five percentage points lower than his or her normal saturation,arouse the patient and check the saturation when fully awake.If the saturation does not improve when fully awake,apply supplemental oxygen and notify the charge nurse or prescriber.

Question 18

After surgery,a patient expresses the fear of becoming addicted to the opioid analgesic that has been prescribed for pain.What is your best response?

Accepted Answer

The fear of addiction to opioids is one cause of poorly treated pain.Remind the patient that addiction will not occur if the drugs are taken to relieve pain.Pain after surgery is acute and temporary pain.The use of opioid drugs,when used for relief of acute pain,even in high doses,rarely results in addiction.

Question 19

Eight weeks after surgery,a patient without pain still takes oxycodone and acetaminophen (Percocet)four to six times a day.What phenomenon do you recognize?

Accepted Answer

Dependence is described as physical changes in autonomic nervous system function that can occur when opioids are used long term and are not needed for pain control.

Question 20

Which side effects are commonly associated with most nonsteroidal anti-inflammatory drugs (NSAIDs)? (select all that apply. )

Accepted Answer

NSAIDs disrupt platelet action and reduce clotting,which increases the risk for bleeding in response to minor trauma.NSAIDs also reduce the thick,gel-like coating of the stomach,allowing normal stomach acids to irritate the stomach lining and form ulcers.Finally,NSAIDs cause the kidneys to retain more sodium and water.These enter the bloodstream and raise blood pressure.

Quiz 7: Drugs for Pain Control

What is the most important question to ask before administering the first dose of celecoxib (Celebrex) to a patient?

You are assigned to care for a patient with chronic low back pain.What adjustment in pain management do you expect to make?

You note all of the following changes in the last week in a 72-year-old nursing home patient taking nortriptyline (Pamelor) for chronic pain.For which problem do you immediately notify the prescriber?

A patient taking warfarin (Coumadin) has mild to moderate pain after exercising.Which over-the-counter pain reliever should you recommend?

A patient is receiving morphine (MS Contin) for severe cancer pain.His wife states that he has difficulty swallowing and asks if the tablets can be crushed and given with applesauce or pudding.What is your best response?

A patient tells you that the usual dose of an opioid drug for cancer pain no longer relieves the pain.What is your best response?

A patient is taking acetaminophen (Tylenol) for mild headache pain.Which precaution is most important for you to teach the patient?

Which key point should you teach a pregnant woman who is prescribed opioids drugs during pregnancy?

You check a patient for pain relief 1 hour after administering 15 mg of morphine intramuscularly.The patient is sleeping and has a respiratory rate of 10 breaths/min.What is your best first action?

After receiving the first dose of an opioid drug,a patient is sleeping and has a respiratory rate of less than 8 per minute.When called by name the patient does not respond.What is your next best action?

What is the best way for you to determine a patient's need for pain medication on the second day after an abdominal laparotomy?

You prepare to give a patient the next scheduled dose of an opioid analgesic.The patient arouses easily but the respiratory rate remains at 10 breaths/min.What is your best first action?

An older adult is taking an oral opioid drug at home for pain control.Which precaution to prevent injury is important for you to teach this patient?

For which opioid pain drug order should you contact and question the prescriber?

A patient taking oxycodone with acetaminophen (Percocet) for pain at home 3 days after fracturing an ankle reports constipation and continuing moderate to severe pain that is relieved by the prescribed drug.What is your best advice?

You are administering the first dose of an opioid drug to a patient.Which specific related actions should you take before and after giving the dose?

The patient who received a first dose of an opioid drug is not arousable and has an oxygen saturation of 88% (five percentage points lower than his or her normal saturation) even when fully awake.What is your best next action?

After surgery,a patient expresses the fear of becoming addicted to the opioid analgesic that has been prescribed for pain.What is your best response?

Eight weeks after surgery,a patient without pain still takes oxycodone and acetaminophen (Percocet) four to six times a day.What phenomenon do you recognize?

Which side effects are commonly associated with most nonsteroidal anti-inflammatory drugs (NSAIDs) ? (select all that apply. )