Chapter 11 Analgesics

Front 1

The physician orders an intramuscular injection of Demerol for the post operative patient’s pain. When preparing to draw up the medication, the nurse is careful to remove the correct vial from the narcotics cabinet. It is labeled
a) simethicone.
b). albuterol.
c). meperidine.
d). ibuprofen.

Back 1

c). meperidine.

Front 2

When administering a drug that has agonist properties, the nurse recognizes it will have what effect?
a) It will occupy the receptor, and block it from action.
b) It will partially block the action of the receptor.
c) It will minimize the effect of the receptor module.
d) It will mimic the action of the receptor to which it binds

Back 2

d) It will mimic the action of the receptor to which it binds

Front 3

What is the difference between epidural analgesia and analgesia given through intravenous route?

a) epidural analgesia has longer effect in the body
b) epidural analgesia has more sedative effect
c) epidural analgesia is more effective in relieving pain
d) epidural analgesia has fewer side effects

Back 3

a) epidural analgesia has longer effect in the body

Front 4


An elderly client is being treated with a fentanyl transdermal patch for moderate pain. The nurse advised this client to:
a) Change the patch site every 2 hours for the first 48 hours.
b) Expect pain relief within 1 hour of application.
c) Take another oral pain medication for 24 hours.
d) Refrain from showering for 24 hours.

Back 4

b) Expect pain relief within 1 hour of application.

Front 5

Pain often is under treated in the elderly. What is the rationale given most often by healthcare providers for that under treatment?
a) Pain is merely the absence of feeling good.
b) Pain is an abstract concept.
c) The elderly frequently complain of pain, so it is hard to believe them consistently.
d) Pain is subjective, and therefore hard to communicate its quality.

Back 5

a) Pain is merely the absence of feeling good.

Front 6

The safest narcotic choice for an elderly client with acute pain is:
a) Meperidine (Demerol).
b) Oxycodone.
c) Fentanyl transdermal patch.
d) Morphine sulfate.

Back 6

d) Morphine sulfate.

Front 7

An elderly client had abdominal surgery six hours earlier. When the nurse asks the client about pain, the client responds that there is none. The best intervention on the part of the nurse is:
a) Administer a PRN dose of IV pain medication as ordered.
b) Assist the client into a sitting position in preparation for ambulation.
c) Question the client further about discomfort to assess the meaning of pain.
d) Assess the abdominal dressing and consult the surgeon about findings.

Back 7

c) Question the client further about discomfort to assess the meaning of pain.

Front 8

A resident of the nursing home has quite severe arthritis. When administering an analgesic to this elderly resident, the nurse should:
a) Give the medication before the activity session in the day room.
b) Give the medication when the resident states the pain is at 6 or higher on a 1-10 pain scale.
c) Give the pain medication at mealtime.
d) Make sure that the medication is not a narcotic.

Back 8

a) Give the medication before the activity session in the day room.

Front 9

Two days after surgery, an elderly client refuses a PRN dose of analgesic dose for fear of becoming "hooked." The nurse should respond by stating that:
a) It is impossible to become hooked on PRN narcotics.
b) Short-term use of narcotics is not likely to cause a person to become dependent on them.
c) Side effects that occur in the elderly mean that medications will be discontinued as soon as possible.
d) The elderly are least likely to become dependent on narcotics.

Back 9

b) Short-term use of narcotics is not likely to cause a person to become dependent on them.

Front 10

When assessing for pain in an elderly nursing home resident who has dementia, the nurse should:
a) Be aware that episodes of incontinence increase in the presence of pain.
b) Look for signs of increased agitation or restlessness.
c) Expect that the resident is able at least to localize the pain.
d) Know that only family members could reliably point out pain in their loved one.

Back 10

b) Look for signs of increased agitation or restlessness.

Front 11

A client is admitted with pulmonary edema. The nurse is preparing to administer morphine sulfate. What beneficial effect does morphine have in pulmonary edema?
a. Decreases anxiety, work of breathing, and vasodilates
b. Decreases respiratory rate
c. Provides an analgesic and sedative effect
d. Decreases anxiety and vasoconstricts

Back 11

a. Decreases anxiety, work of breathing, and vasodilates

Front 12

When administering IV analgesics to the elderly, the nurse should expect:
a). To "start low and go slow."
b) The response to the medication will be more rapid than in younger clients.
c) That PCA administration will be the most effective method.
d) Wait for a more thorough assessment to be completed before administering the medication.

Back 12

a). To "start low and go slow."

Front 13

Non-pharmacological interventions for pain that the nurse might employ for an elderly client with osteoporosis would include:
a) Evening back rubs.
b) Support groups.
c) Daily walks.
d) Daily exercises.

Back 13

a) Evening back rubs.

Front 14

When an elderly client with cancer experiences "breakthrough pain," the nurse should expect that pharmacological treatment will include:
a) Initiation of a placebo after every third dose of narcotic.
b) More aggressive chemotherapy.
c) Giving narcotics every hour.
d) Increasing the dose of the narcotic.

Back 14

d) Increasing the dose of the narcotic.

Front 15

A client is admitted with pulmonary edema. The nurse is preparing to administer morphine sulfate. What beneficial effect does morphine have in pulmonary edema?
a. Decreases anxiety, work of breathing, and vasodilates
b. Decreases respiratory rate
c. Provides an analgesic and sedative effect
d. Decreases anxiety and vasoconstricts

Back 15

a. Decreases anxiety, work of breathing, and vasodilates

Front 16

When administering IV analgesics to the elderly, the nurse should expect:
a). To "start low and go slow."
b) The response to the medication will be more rapid than in younger clients.
c) That PCA administration will be the most effective method.
d) Wait for a more thorough assessment to be completed before administering the medication.

Back 16

a). To "start low and go slow."

Front 17

Non-pharmacological interventions for pain that the nurse might employ for an elderly client with osteoporosis would include:
a) Evening back rubs.
b) Support groups.
c) Daily walks.
d) Daily exercises.

Back 17

a) Evening back rubs.

Front 18

When an elderly client with cancer experiences "breakthrough pain," the nurse should expect that pharmacological treatment will include:
a) Initiation of a placebo after every third dose of narcotic.
b) More aggressive chemotherapy.
c) Giving narcotics every hour.
d) Increasing the dose of the narcotic.

Back 18

d) Increasing the dose of the narcotic.

Front 19

When assessing a patient for adverse effects related to morphine sulfate, which effects would the nurse expect to find? (Select all that apply.)
A) Decreased peristalsis
B) Diarrhea
C) Delayed gastric emptying
D) Urinary retention

Back 19

A) Decreased peristalsis
C) Delayed gastric emptying
D) Urinary retention

Front 20

A patient needs to switch analgesic drugs secondary to an adverse reaction to the present regimen. The patient is concerned that he will not receive an effective dose of a new drug to control pain. The nurse responds based on knowledge that potencies of analgesics are determined using an equianalgesic table comparing doses with that of
A) meperidine.
B) fentanyl.
C) codeine.
D) morphine.

Back 20

D) morphine.

Front 21

A patient is admitted to the psychiatric unit for treatment of narcotic addiction.  The nurse would anticipate administration of which medication?
A) Morphine
B) Methadone
C) Meperidine
D) Naloxone

Back 21

B) Methadone

Front 22

A patient has been admitted after overdosing on acetaminophen (Tylenol), with a total ingested dose of 14 g over a period of 1 hour. The nurse plans to monitor this patient for development of which of the following signs and symptoms related to the overdose?
A) Renal failure
B) Kidney stones
C) Acute hepatic necrosis
D) Metabolic alkalosis

Back 22

C) Acute hepatic necrosis

Front 23

While admitting a patient for treatment of an acetaminophen overdose, the nurse prepares to administer which of the following medications to prevent toxicity?
A) naloxone (Narcan)
B) acetylcysteine (Mucomyst)
C) methylprednisolone (Solu-Medrol)
D) vitamin K

Back 23

B) acetylcysteine (Mucomyst)

Front 24

Massage therapy is ordered as adjunct treatment for a patient with musculoskeletal pain. The patient asks the nurse how “rubbing my muscles” will help the pain go away. The nurse responds based on the knowledge that
A) massaging muscles decreases the inflammatory response that initiates the painful stimuli.
B) massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain.
C) massaging muscles activates small sensory nerve fibers that send signals to the spinal cord to open the gate and allow endorphins to reach the muscles and relieve the pain.
D) massaging muscles helps relax the contracted fibers and decrease painful stimuli.

Back 24

B) massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain.

Front 25

When assessing for the most serious adverse reaction to a narcotic analgesic, the nurse is careful to monitor the patient’s
A) respiratory rate.
B) heart rate.
C) blood pressure.
D) mental status.

Back 25

A) respiratory rate.

Front 26

Which medication is used to treat a patient suffering from severe adverse effects of a narcotic analgesic?
A) naloxone (Narcan)
B) acetylcysteine (Mucomyst)
C) methylprednisolone (Solu-Medrol)
D) protamine sulfate

Back 26

A) naloxone (Narcan)

Front 27

A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse why she is receiving codeine when she does not have any pain. The nurse’s response is based on knowledge that codeine also has what effect?
A) Stimulation of the immune system
B) Cough suppressant
C) Expectorant
D) Bronchodilation

Back 27

B) Cough suppressant

Front 28

In monitoring a patient for adverse effects related to morphine sulfate, the nurse assesses for stimulation of
A) autonomic control over circulation.
B) cough reflex center.
C) chemoreceptor trigger zone.
D) respiratory rate and depth.

Back 28

C) chemoreceptor trigger zone.

Front 29

The nurse is preparing to administer an injection of morphine to a patient. Assessment notes a respiratory rate of 10 breaths/min. Which action will the nurse perform?
A) Administer a smaller dose and record the findings
B) Notify the physician and delay drug administration
C) Administer the prescribed dose and notify the physician
D) Hold the drug, record the assessment, and recheck in 1 hour

Back 29

B) Notify the physician and delay drug administration

Front 30

A patient receiving narcotic analgesics for chronic pain can minimize the gastrointestinal (GI) side effects by
A) taking Lomotil with each dose.
B) eating foods high in lactobacilli.
C) taking the medication on an empty stomach.
D) increasing fluid and fiber in the diet.

Back 30

D) increasing fluid and fiber in the diet.

Front 31

The nurse teaches a patient prescribed the fentanyl (Duragesic) transdermal delivery system to change the patch at what interval?
A) When pain recurs
B) Every 24 hours
C) Every 72 hours
D) Once a week

Back 31

C) Every 72 hours

Front 32

The nurse plans pharmacologic therapy for a patient with pain based on the knowledge that
A) narcotic analgesics should not be used for more than 24 hours secondary to the risk of addiction.
B) analgesics should be administered as needed (prn) to minimize side effects.
C) pain relief is best obtained by administering analgesics around the clock.
D) patients should request analgesics when the pain level reaches a “6” on a scale of 1 to 10.

Back 32

C) pain relief is best obtained by administering analgesics around the clock.

Front 33

In developing a plan of care for a patient receiving morphine sulfate, which nursing diagnosis is a priority?
A) Acute pain
B) Risk for injury related to central nervous system side effects
C) Impaired gas exchange related to respiratory depression
D) Constipation related to gastrointestinal side effects

Back 33

C) Impaired gas exchange related to respiratory depression

Front 34

The receptors most responsive to drug therapy are (Select all that apply)
a). mu
b). kappa
c). omega
d). delta

Back 34

a). mu
b). kappa
d). delta

Front 35

The mechanism of action and drug effects for opioids include (select all that apply)
a). agonist
b). antagonist-antagonist
c). agonist-antagonist
d). antagonist

Back 35

a). agonist
c). agonist-antagonist
d). antagonist

Front 36

Which mechanism of opioid action is best described by binding to an opioid receptor in the brain and causing an analgesic response
a). agonist
b). antagonist
c). agonist-antagonist
d). partial agonist

Back 36

a). agonist

Front 37

Which mechanism of opioid action would be preferred if the desired outcome was to compete and reverse the effects of an agonist or agonist-antagonist.
a). agonist
b). antagonist
c). agonist-antagonist
d). partial agonist

Back 37

b). antagonist

Front 38

The characteristics of a particular opioid, such as the ability to sedate, its potency, and its ability to cause hallucinations can be attributed to
a). relatively long half life
b). onset of action
c). mechanism of action
d). the relative affinity for the various receptors

Back 38

d). the relative affinity for the various receptors

Front 39

The nurse teaching about the appropriate use of transdermal patches would consider more teaching is necessary when the patient states
a). I should fold the sticky sides of the patch together and flush down the toilet
b). If pain persist I can use a heating pad as an aid over the site
c). I should notify my doctor if I experience respiratory depression
d). I should not use a transdermal patch for postoperative or short term pain control

Back 39

b). If pain persist I can use a heating pad as an aid over the site

Front 40

A nurse treating a patient who has just returned from total hip replacement would consider the use of of which strong opioids (Select all that apply)
a). morphine
b). oxycodone
c). hydromorphone
d).transdermal fentanyl
e). meperidine

Back 40

a). morphine
b). oxycodone
c). hydromorphone
e). meperidine

Front 41

What should the nurse consider when administering opioids to the elderly patient (select all that apply)
a). weight and height
b). respiratory rate
c). changes in levels of consciousness
d). obstructive urinary disease
e). benign prostatic hyperplasia

Back 41

a). weight and height
b). respiratory rate
c). changes in levels of consciousness
d). obstructive urinary disease
e). benign prostatic hyperplasia

Front 42

The withdrawal symptoms resulting from discontinuance or reversal therapy with short acting opioids codeine, hydrocodone, morphine, and hydromorphone will appear within
A) 6 to 12 hours and peaks at 24 to 72 hours
B) 1 to 3 hours
C) 1 to 3 hours and peaks within 24 hours
D) immediately

Back 42

A) 6 to 12 hours and peaks at 24 to 72 hours

Front 43

The withdrawal symptoms resulting from discontinuance or reversal therapy with long half life opioids metahadone, levorphanol, and transdermal fentanyl will appear within
A) 6 to 12 hours
B) 24 hours or more and will be milder
C) 1-3 hours
D) immediately

Back 43

B) 24 hours or more and will be milder

Front 44

A nurse advising a patient of some of the adverse affects of opioid use would tell the patient she might experiance (select all that apply)
a). CNS depression
b.) constipation
c). urinary retention
d). nausea or vomiting
e). flush or rash
f). diaherria

Back 44

a). CNS depression
b.) constipation
c). urinary retention
d). nausea or vomiting
e). flush or rash

Front 45

A client who recently received an opioid for pain is experiencing constipation, to alleviate her symptoms the nurse would use which measures to manage the effects (select all that apply)
a). increased intake of fluids
b.) give a dose of docusate sodium
c). use the mild cathartic senna
d). use the bulk forming laxative psyllium
e). increase fiber

Back 45

a). increased intake of fluids
b.) give a dose of docusate sodium
c). use the mild cathartic senna
d). use the bulk forming laxative psyllium

Front 46

A client who recently received an opioid for pain is experiencing nausea, to alleviate her symptoms the nurse would use which measure to manage the effects
a). increased intake of fluids
b). use antiemetic phenothiazines
c). exercise
d). decrease dosage of medication

Back 46

b). use antiemetic phenothiazines

Front 47

Because of morphines potentially toxic metabolite morphine-6-glucuronide, a safer analgesic choice for a patient with renal impairment would be (select all that apply)
a). hydromorphone (Dilaudid)
b). codeine sulfate
c). fentanyl
d). oxymorphone (Opana)

Back 47

a). hydromorphone (Dilaudid)
c). fentanyl
d). oxymorphone (Opana)

Front 48

In choosing an analgesic, the nurse is aware that Codeine Sulfate possesses a ceiling effect and would therefore most likely be used as (select all that apply)
a). antitussive
b). control of mild to moderate pain
c). preoperative sedation
d). treatment of overdose

Back 48

a). antitussive
b). control of mild to moderate pain

Front 49

When giving hydromorphone for pain one of the things the nurse should keep in mind is
a). it may cause diarrhea
b). it may lead to an increase heart rate
c). its eight times more potent than morphine and doses should be reduced accordingly
d). it’s an opioid antagonist that can be given to counteract the effects of overdosing

Back 49

c). its eight times more potent than morphine and doses should be reduced accordingly

Front 50

Co-administration of opioids with alcohol, antihistimines, barbituates, benzodiazephines, phenopthiazines and other CNS depressants will lead to
a). toxicity
b). increase risk of death
c). nervousness
d). additive respiratory depressant effects

Back 50

d). additive respiratory depressant effects

Front 51

Naloxone and naltrexone are used primarily in (select all that apply)
a). short term pain management
b). management of opioid addiction
c). opioid overdose
d). reversing the adverse effects induced by opioid drugs, such as respiratory depression

Back 51

b). management of opioid addiction
c). opioid overdose
d). reversing the adverse effects induced by opioid drugs, such as respiratory depression

Front 52

Opioids that have an affinity for mu receptors and have a rapid onset of action (select all that apply)
a). are antagonists
b). produce marked euphoria
c). are contraindicated in those with diabetes
d). are most likely to be abused and used recreationally

Back 52

b). produce marked euphoria
d). are most likely to be abused and used recreationally

Front 53

Strong opioids such as fentanyl, sufentanil, alfentanil are commonly used (select all that apply)
a). as adjunct drugs with anesthetics during surgery
b). as cough suppressants
c). to relieve moderate to severe pain
d). to counteract the effects of agonist opioids

Back 53

a). as adjunct drugs with anesthetics during surgery
c). to relieve moderate to severe pain

Front 54

The oral and transdermal forms of fentanyl are primarily used
a). in preoperative settings and in intensive care settings for sedation during mechanical ventilation
b). in postoperative care for short term management of pain
c). for long term control of both malignant and nonmalignant chronic pain including cancer pain
d). as an obstetric analgesia

Back 54

c). for long term control of both malignant and nonmalignant chronic pain including cancer pain

Front 55

Before administering a fentanyl patch to a patient experiencing cancer induced pain, the nurse should (select all that apply)
a). administer to an opioid tolerant patient whose pain is not adequately controlled by other types of medications
b). should be used to relieve mild to moderate pain
c). know that it will require a supplemental short acting therapy
d.) consider after the first patch is applied it will take 6 to 12 hours to reach a steady state pain control

Back 55

a). administer to an opioid tolerant patient whose pain is not adequately controlled by other types of medications
c). know that it will require a supplemental short acting therapy
d.) consider after the first patch is applied it will take 6 to 12 hours to reach a steady state pain control

Front 56

When assessing a patient taking opioids the nurse woulds consider which of the following to be a priority
a). a respiration rate of 12 breaths per minute
b). a rash which produces itching
c). signs of GI distress
d). pinpoint pupils

Back 56

d). pinpoint pupils

Front 57

Two of the most commonly used opioids given for the suppression of cough are
a). codeine and hydrocodone
b). oxycotin and MS cotin
c). naloxone (Narcan) and naltrexone (ReVia)
d). acetaminophen (Tylenol) and tramadol (Ultram)

Back 57

a). codeine and hydrocodone

Front 58

These types of opioids bind to pain receptors and cause a partial response that is not as strong
a). agonist
b). agonist-antagonist
c). antagonist
d). nonanalgesic anatagonist

Back 58

b). agonist-antagonist

Front 59

When administering opioids to an elderly patient a nurse should consider (select all that apply)
a). smaller dosages because of increase sensitivity to CNS depression
b). paradoxical reactions are more likely
c). elderly patients are more likely to develop opioid dependency
d) may experience diminishment of urinary outflow because of urinary retention

Back 59

a). smaller dosages because of increase sensitivity to CNS depression
b). paradoxical reactions are more likely
d) may experience diminishment of urinary outflow because of urinary retention

Front 60

What nursing interventions should a nurse implement for an elderly patient receiving opioids for pain intervention (select all that apply)
a). document weight and height before beginning therapy
b). use the 0 to 5 ouch scale to assess for pain
c), make regimen as simple as possible to enhance compliance
d). pay attention to level of consciousness and cognitive impairments
e). get a complete list of medications
f). keep the environment safe with call bells, bed rails, and bed side lights

Back 60

a). document weight and height before beginning therapy
c), make regimen as simple as possible to enhance compliance
d). pay attention to level of consciousness and cognitive impairments
e). get a complete list of medications

Front 61

This synthetic opioid analgesic should be used with extreme caution and is contraindicated for elderly patients, patients who require long term analgesia, or who have kidney disfunction. It can accumulate to toxic levels and lead to seizures.
a). Codeine
b).Hydrocodone
c).Meperidine (Demerol)
d).Methadone (Dolophine)

Back 61

c).Meperidine (Demerol)

Front 62

A patient who is admitted to the emergency room and is experiencing an acute migraine headache would be given an oral or injectable form of which of these opioid
a).Hydrocodone
b).Meperidine (Demerol)
c).Methadone (Dolophine)
d). Morphine

Back 62

b).Meperidine (Demerol)

Front 63

This schedule II opioid can be given as an epidural analgesic with a doctors order. It has a potential for hazards arising from increased intracranial pressure, especially from multiple injections and increase CNS depression when given with other CNS depressants
a).Hydrocodone
b).Meperidine (Demerol)
c).Methadone (Dolophine)
d). Morphine sulfate

Back 63

d). Morphine sulfate

Front 64

This schedule II opioid is used to treat moderate to severe pain, it is available in parenteral injections, transdermal patches(Duragesic), buccal lozenges (Fentora), buccal lozenges on a stick (Actiq), and it is extremely potent with 0.1 mg IV being equivalent to 10 mg of morphine IV. It is best used for non escalating pain because of the difficulty of titrating doses
a) Fentanyl
b). Codeine
c).Hydrocodone
d).Meperidine (Demerol)

Back 64

a) Fentanyl

Front 65

This synthetic opioid is unique in that its half life is longer than its duration of activity. Because the drug binds to the tissue of the liver, kidneys, and brain with repeated doses, the accumulation of the drug in these tissues causes a slow release thus allowing 24 hour dosing. It is eliminated through liver making it safer choice for patients with renal impairment but may cause cardiac dysrhythmias
a). Codeine
b). Methadone (Dolophine)
c). Oxycodone (Percodan/Percocet, Tylox)
d). Fentanyl (Duragesic)

Back 65

b). Methadone (Dolophine)

Front 66

Tramadol and transdermal lidocaine are examples of what class of drugs
A) opioids
B) non-opioid analgesics
C) codeine
D) opioid antagonist

Back 66

B) non-opioid analgesics

Front 67

A patient undergoing withdrawal from opioid addiction is given methadone to counteract the effects. The nurse can expect to re administer the medication
a). 2 to4 hours
b). 30 to 60 minutes
c). 22 to 48 hours
d). 6 to 7 hours

Back 67

c). 22 to 48 hours

Front 68

The nurse would advise a patient who has been receiving the opioid antagonist naltrexone (Revia) orally as an adjunct to psychosocial treatment of alcoholism to expect these common adverse effects (select all that apply)
a). nausea
b) dry mouth
c) tachycardia
d) decreased respiratory function

Back 68

a). nausea
c) tachycardia

Front 69

Naltrexone (ReVia) is contraindicated in patients with (select all that apply)
a). hepatitis
b). diabetes
c). opioid addiction
d). severe liver dysfunction

Back 69

a). hepatitis
d) severe liver dysfunction

Front 70

This class of drugs is used for the management of pain, especially associated with inflammatory conditions such as arthritus. They have both a significant anti-inflammatory and analgesic effect.
a) opioids
b) non-opioid analgesics
c) codeine
d) opioid antagonist

Back 70

b) non-opioid analgesics

Front 71

While both aspirin and acetaminophen are both non-opioid analgesic drugs used for the management of pain acetaminophen is often chosen over aspirin because: (select all that apply)
a). it does not have cardio vascular effects such as edema
b). it does not have platelet effects
c). it does not cause GI tract irritations
d). it does not cause any adverse effects such as rash, nausea, and vomiting
e). it does not cause acid bases changes

Back 71

a). it does not have cardio vascular effects such as edema
b). it does not have platelet effects
c). it does not cause GI tract irritations
e). it does not cause acid bases changes

Front 72

A ten year old boy is admitted to the hospital with suspected signs and symptoms of the flu. He is running a fever of 103 and has no known drug allergies. However he is complaining of moderate associated pain. The most appropriate medication choice would be
a) acetaminophen (Tylenol)
b) hydrocodone
c) aspirin
d) codeine

Back 72

a) acetaminophen (Tylenol)

Front 73

A 17 year old boy is admitted into the hospital having been suspected of ingesting in excess of 4000 mg/kg of acetaminophen. To reverse the possible effects of hepatic necrosis, the physician would ask the nurse to administer which drug no sooner than four hours after suspected ingestion:
a) naxolone (narcan)
b) methadone HCl
c) acetylcysteine
d) naltrexone (ReVia)

Back 73

c) acetylcysteine

Front 74

Because this drug smells like rotten eggs, the patient vomits the oral dose, as an alternative to the oral dose the physician would most likely choose this form of drug three times over a 21 hour period:
a) acetylcysteine (Acetadote)
b) IV naxolone (Narcan)
c) meperidine HCl (Demerol)
d) IV naltrexone (ReVia)

Back 74

a) acetylcysteine (Acetadote)

Front 75

A nurse providing teaching to a patient of the appropriate dosing of acetaminophen would advise the patient that:
A) taking acetaminophen with phenytoin, barbiturates, warfarin, isoniazid, rifampin, beta blockers, and anticholinergic drugs has not been shown to be harmful
B) if you consume moderate to large amounts of alcohol you should not exceed 2000 mg of acetaminophen
C) You should avoid taking acetaminophen if you are allergic to aspirin
D) If pain persist it is ok to take up to 5000 mg/kg per day of acetaminophen

Back 75

B) if you consume moderate to large amounts of alcohol you should not exceed 2000 mg of acetaminophen

Front 76

This drug is classified as a miscellaneous analgesic and is used for the treatment of moderate to moderately severe pain. It is unique in that it has a dual mechanism of action creating a weak bond to the mu receptors and inhibiting the re-uptake of norepinephrine and serotonin
A) acetaminophen
B) lidocanine, transdermal
C) tramadol HCl (Ultram)
D) ziconotide (Prialt)

Back 76

C) tramadol HCl (Ultram)

Front 77

When giving Ziconotide in addition to vital signs, the nurse should assess for (select all that apply)
a). CNS depression
b). abnormal bleeding
c). infection at site
d). problem involving spinal fluid

Back 77

b). abnormal bleeding
c). infection at site
d). problem involving spinal fluid

Front 78

Use of the NSAID’s such as ibuprofen, aspirin and COX-2 inhibitors requires assessment of (select all that apply)
a). renal and liver function
b). GI disorders
c). blood glucose levels
d). age

Back 78

a). renal and liver function
b). GI disorders
d). age

Front 79

A 75 year old patient currently taking SSRI’s is experiencing drowsiness, dizziness, headache, nausea, constipation, respiratory depression. Shortly after the administration of his pain medication he begins to seizure. The patient is most likely experiencing the severe adverse effects of
a). ziconotide (Prialt)
b).tramadol
c). acetaminophen (Tylenol)
d). lidocaine

Back 79

b).tramadol

Front 80

A patient experiencing severe psychotic symptoms and neurologic impairment, reduced cognitive function, changes in mood and level of consciousness and hallucinations may be experience adverse effects to which drug
a).tramadol
b). acetaminophen (Tylenol)
c). lidocaine
d). ziconotide (Prialt)

Back 80

d). ziconotide (Prialt)

Front 81

A patient with postherpetic neuralgia-painful skin condition from shingles would most likely be given which drug for relief of local pain expected to last 4- 12 hours
a) Lidocaine, transdermal (Lidoderm)
b).tramadol
c). acetaminophen (Tylenol)
d). ziconotide (Prialt)

Back 81

a) Lidocaine, transdermal (Lidoderm)

Front 82

A nurse educating her client on the signs and symptoms of acetaminophen overdoes would consider no further teaching is necessary when the patient states
a). acetaminophen should not be given to children or the elderly because of increase risk for toxicity
b). acetaminophen tablets may be crushed if needed
c). any signs of bleeding, loss of energy, fever, sore throat, and easy bruising should be reported immediately
d). is contraindicated in patients who are anemic or who have renal hepatic disease such as hepatitis

Back 82

c). any signs of bleeding, loss of energy, fever, sore throat, and easy bruising should be reported immediately

Front 83

A nurse is aware that when giving a an agoinist-antagonist at the same time with another opioid that
a). they are effective analgesics because they bind with opiate receptors and produce and agonist effect
b). they will lead to a reversal of analgesia and acute withdrawal because of the blocking of opiate receptors
c). they will result in increase toxicity
d). they will result in a decrease in respiratory function

Back 83

b). they will lead to a reversal of analgesia and acute withdrawal because of the blocking of opiate receptors

Front 84

A patient with bone pain caused by metastatic cancer experiences break through pain. The nurse would most likely be ordered to give
a). Meperidine (Demerol)
b). Codeine
c). Hydrocodone
d). Fentanyl

Back 84

d). Fentanyl

Front 85

When managing pain the nurse should: (select all that apply)
a). individualize plan of care based on the patients holistic and cultural being
b). manage mild pain with use of non-opioid drugs such as acetaminophen, tramadol, and other NSAID’s
c). manage moderate severe pain with a stepped approach using opioids
always consider the use of nonpharmacologic comfort measures
e). administer analgesics as ordered before pain gets out of control

Back 85

a). individualize plan of care based on the patients holistic and cultural being
b). manage mild pain with use of non-opioid drugs such as acetaminophen, tramadol, and other NSAID’s
c). manage moderate severe pain with a stepped approach using opioids
always consider the use of nonpharmacologic comfort measures
e). administer analgesics as ordered before pain gets out of control

Front 86

A 20 year old female patient with a history of opioid addiction is recovering from an obstetric procedures. The nurse is most likely ordered to administer (select all that apply)
A) fentanyl
B) butorphanol (Stadol)
C) Meperidine hydrochloride (Demerol)
D) butorphanol (Stadol)

Back 86

B) butorphanol (Stadol)
D) butorphanol (Stadol)

Front 87

A nurse ordered to administer Ziconotide (Prialt) for severe chronic pain that is refractory pain would assess for (select all that apply)
a). abnormal bleeding
b). bowel movements
c).preexisting psychoses
d). problems with spinal fluid

Back 87

a). abnormal bleeding
c).preexisting psychoses
d). problems with spinal fluid

Front 88

Opioid antagonist should administered to (select all that apply)
a). opioid naive patients
b). to counteract the effects of an acetaminophen overdose
c). when patient is receiving a PCA with an opioid
d). to patients suspected of aspirin allergies

Back 88

a). opioid naive patients
c). when patient is receiving a PCA with an opioid