Lilley: Pharmacology and the Nursing Process, 6th Edition

Test Bank

Chapter 11: Analgesic Drugs

MULTIPLE CHOICE

1.A patient was diagnosed with pancreatic cancer last month, and she has complained of a dull ache in her abdomen for the past 4 months. This pain has been gradually increasing, and the pain relievers she has taken at home are no longer effective. What type of pain is she experiencing?

A. Acute pain

B. Chronic pain

C. Somatic pain

D. Superficial pain

ANS: B

Chronic pain is associated with cancer and is characterized by slow onset, long duration, and dull, persistent aching. The patient’s symptoms are not characteristics of acute pain, somatic pain, or superficial pain.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 153

TOP:NURSING PROCESS: Assessment

MSC:NCLEX: Physiological Integrity: Basic Care and Comfort

2.An 18-year-old basketball player fell and twisted his 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 analgesic, such as indomethacin

ANS: D

Somatic pain, originating from skeletal muscles, ligaments, and joints, usually responds to nonopioid analgesics, such as nonsteroidal antiinflammatory drugs (NSAIDs). The other options are not the best choices for somatic pain.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 154

TOP:NURSING PROCESS: Assessment

MSC:NCLEX: Physiological Integrity: Basic Care and Comfort

3.A patient is recovering from abdominal surgery, which he had this morning. He is groggy but complaining of severe pain around his incision. What is the most important thing for the nurse to consider during an assessment before administering a dose of morphine sulfate to the patient?

A. His temperature

B. His respiration rate

C. The appearance of the incision

D. The date of his last bowel movement

ANS: B

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 not correct.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 160

TOP:NURSING PROCESS: Assessment

MSC:NCLEX: Physiological Integrity: Reduction of Risk Potential

4.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 9 per minute. The nurse prepares for which action at this time?

A. Close observation of signs of opioid tolerance

B. Immediate intubation and artificial ventilation

C. Administration of naloxone (Narcan), an opioid reversal agent

D. Administration of an agonist opioid such as fentanyl

ANS: C

Naloxone, an opioid-reversal agent, is used to reverse the effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression. This situation is describing an opioid overdose, not opioid tolerance. Intubation and artificial ventilation are not appropriate because the patient is still breathing at nine breaths per minute. It would be inappropriate to administer an opioid agonist.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 161

TOP:NURSING PROCESS: Implementation

MSC:NCLEX: Physiological Integrity: Pharmacological Therapies

5.A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after abdominal surgery. The nurse should include which information in the teaching plan?

A. Management of diarrhea

B. Drug addiction programs

C. Prevention of constipation

D. Dehydration due to polyuria

ANS: C

Gastrointestinal adverse effects, such as nausea, vomiting, and constipation, are the most common adverse effects associated with opioid analgesics. Physical dependence usually occurs in patients undergoing long-term treatment. Diarrhea and polyuria are not effects of opioid analgesics.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Pages 160-161

TOP:NURSING PROCESS: Implementation

MSC:NCLEX: Physiological Integrity: Reduction of Risk Potential

6.A patient has been treated for lung cancer for 3 years. Over the past few months, she has noticed that the opioid analgesic she has been taking is not helping as much as it had previously and says she needs to take more medication for the same pain relief. The nurse is aware that this patient is experiencing opioid

A. toxicity.

B. addiction.

C. tolerance.

D. abstinence syndrome.

ANS: C

Opioid tolerance is a common physiologic result of long-term opioid use. Patients with opioid tolerance require larger doses of the opioid agent to maintain the same level of analgesia. This situation does not describe toxicity (overdose), addiction, or abstinence syndrome (withdrawal).

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 156

TOP:NURSING PROCESS: Evaluation

MSC:NCLEX: Physiological Integrity: Pharmacological Therapies

7.A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is

A. tachycardia.

B. depression of the central nervous system.

C. hepatic necrosis.

D. nephropathy.

ANS: C

Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen. The other options are not correct.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 165

TOP:NURSING PROCESS: Assessment

MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

8.A 57-year-old woman being treated for end-stage breast cancer has been using a transdermal opioid analgesic as part of the management of pain. Lately, she has been experiencing breakthrough pain. The nurse should expect this type of pain to be managed by

A. administering NSAIDs.

B. administering an immediate-release opioid.

C. changing the opioid route to the rectal route.

D. not changing the current therapy.

ANS: B

If a patient is taking long-acting opioid analgesics, breakthrough pain must be treated with an immediate-release dosage form that is given between scheduled doses of the long-acting opioid. The other options are not appropriate actions.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 157

TOP:NURSING PROCESS: Planning

MSC:NCLEX: Physiological Integrity: Pharmacological Therapies

9.The nurse is reviewing herbal therapies. Which is a common use of the herb feverfew?

A. Muscle aches

B. Migraine headaches

C. Leg cramps

D. Incision pain after surgery

ANS: B

Feverfew is commonly used for migraine headaches, menstrual problems, arthritis, and fever. Possible adverse effects include muscle stiffness and muscle and joint pain.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: Page 171

TOP:NURSING PROCESS: Planning

MSC:NCLEX: Physiological Integrity: Pharmacological Therapies

10.A patient is to receive acetylcysteine (Mucomyst) as part of the treatment for an acetaminophen (Tylenol) overdose. Which action by the nurse is appropriate when giving this medication?

A. Giving the medication undiluted for full effect

B. Avoiding use of a straw when giving this medication

C. Disguising the flavor with soda or flavored water

D. Preparing to give this medication via a nebulizer

ANS: C

Acetylcysteine has the flavor of rotten eggs and so is better tolerated if it is diluted and disguised by mixing with a drink such as cola or flavored water to help increase its palatability. The use of a straw helps to minimize contact with the mucous membranes of the mouth and is recommended. The nebulizer form of this medication is used for certain types of pneumonia, not for acetaminophen overdose.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 171

TOP:NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies