Question 1

Which side effects of opioid analgesics can have therapeutic benefits? (Select all that apply.)

Accepted Answer

Individual effects of morphine may be beneficial,detrimental,or both. Cough suppression is usually beneficial; suppression of bowel motility and vasodilation can be either beneficial or detrimental. Biliary colic and urinary retention are always detrimental side effects.

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

Use of morphine or other opioids during delivery can cause respiratory depression in the neonate,because the drug crosses the placenta. Infants should be monitored for respiratory depression and receive naloxone if needed. Opioids given during delivery do not contribute to birth defects in the newborn. Excessive crying and sneezing and tremors and hyperreflexia are signs of neonatal opioid dependence,which occurs with long-term opioid use by the mother during pregnancy and not with short-term use of these drugs during labor.

Question 3

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

The classic triad of symptoms of opioid overdose are coma,respiratory depression,and pinpoint pupils. The pupils may dilate as hypoxia worsens,and this symptom,along with continued respiratory depression (fewer than 12 breaths per minute),indicates worsening hypoxia. Fentanyl is a strong opioid,so this is not likely to be a mild overdose,because the patient was wearing two patches. Fentanyl continues to be absorbed even after the patches are removed because of residual drug in the skin,so the drug levels are not likely to be decreasing. The patient does not have improved ventilation,because the respiratory rate is still fewer than 12 breaths per minute.

Question 4

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 per minute,the respiratory rate is 10 breaths per minute,and the blood pressure is 90/50 mm Hg. What will the nurse do?

Accepted Answer

Opioid toxicity is characterized by coma,respiratory depression,and pinpoint pupils. Although pupils are constricted initially,they may dilate as hypoxia progresses,which also causes blood pressure to drop. This patient has a respiratory rate of fewer than 12 breaths per minute,dilated pupils,and low blood pressure; the patient also is showing signs of central nervous system (CNS)depression. The nurse should prepare to give naloxone and should watch the patient closely for respiratory collapse. Patients with opioid dependence show withdrawal symptoms when the drug is discontinued. When postoperative patients have adequate analgesia without serious side effects,encouraging patients to turn,cough,and breathe deeply is appropriate. This patient is probably relatively pain free,but providing emergency treatment is the priority.

Question 5

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

Oxycodone is useful for moderate to severe pain,and a continued-release preparation may give more continuous relief. Dosing is every 12 hours,not PRN. A combination product is not recommended with increasing pain,because the nonopioid portion of the medication cannot be increased indefinitely. This patient does not demonstrate drug-seeking behaviors. Physical dependence is not an indication for withdrawing an opioid,as long as it is still needed; it indicates a need for withdrawing the drug slowly when the drug is discontinued.

Question 6

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

Patients using the buprenorphine transdermal patch should be cautioned against heat,heating pads,hot baths,saunas,and prolonged sun exposure. The skin should be cleaned with water only. The patch should stay on for 7 days before a new patch is applied. Patients should remove hair by clipping,not shaving.

Question 7

A nurse is administering morphine sulfate to a postoperative patient. Which are appropriate routine nursing actions when giving this drug? (Select all that apply.)

Accepted Answer

Respiratory depression,constipation,and urinary retention are common adverse effects of opioid analgesics. It is important to count respirations before giving the drug and periodically thereafter to make sure that respiratory depression has not occurred. Increased physical activity,increased fluid intake,and increased fiber help alleviate constipation. It is important to assess the patient's abdomen and palpate the bladder to make sure that urinary retention has not occurred. Patients taking morphine often experience hypotension,not hypertension. Methylnaltrexone is given as a last resort to treat constipation,because it blocks mu receptors in the intestine.

Question 8

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

Methadone prolongs the QT interval. It does not prolong the P-R interval,cause AV block,or produce an elevated QRS complex.

Question 9

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

Opioids can induce spasm of the common bile duct and can cause biliary colic. For patients with existing biliary colic,morphine may intensify the pain. It is important to treat pain,however,and certain opioids,such as meperidine,which cause less smooth muscle spasm,may be given. Ibuprofen is used for mild to moderate pain and is not appropriate for this patient. Nonpharmacologic methods are appropriate when used as adjunctive therapy with an opioid.

Question 10

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

Transdermal fentanyl is indicated only for persistent,severe pain in patients already opioid tolerant. Hydrocodone,a combination product,has actions similar to codeine and is not used for severe,chronic pain. Meperidine is not recommended for continued use because of the risk of harm caused by the accumulation of a toxic metabolite. Pentazocine is an agonist-antagonist opioid and is less effective for pain; moreover,when given to a patient who is already opioid tolerant,it can precipitate an acute withdrawal syndrome.

Question 11

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

Accepted Answer

Patients who develop tolerance to opioids will develop tolerance to its analgesic,euphoric,and sedative effects and will also develop tolerance to respiratory depression. Very little tolerance develops to constipation.

Question 12

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

Accepted Answer

This patient is developing tolerance,which occurs over time and is evidenced by the need for a larger dose to produce the effect formerly produced by a smaller dose. This patient should be encouraged to request an increased dose. PRN dosing is less effective than scheduled,around-the-clock dosing. The risk of respiratory depression decreases over time as patients develop tolerance to this effect. Benzodiazepines are CNS depressants and should not be given with opioids,because they increase the risk of oversedation.

Question 13

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

The nurse should instruct parents not to activate the PCA when their child is sleeping because that can lead to drug overdose. Postoperative pain should be treated appropriately with medications that are effective. Nonopioid medications are not sufficient to treat postoperative pain. Patients should be encouraged to use the PCA as needed so that pain can be controlled in a timely fashion. PRN dosing is not as effective as dosing that is continuous,so a basal dose should be given as well as a PRN dose.

Question 14

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

Pentazocine is an agonist-antagonist opioid,and when given to a patient who is physically dependent on morphine,it can precipitate withdrawal. Yawning and sweating are early signs of opioid withdrawal. Pentazocine does not produce euphoria,hypotension,or respiratory depression.

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