Chapter 10 - Analgesic Drugs

Lilley: Pharmacology and the Nursing Process, 7th 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 gradual-
ly 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

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.

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.

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

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).

TOP: NURSING PROCESS: Evaluation
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.

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.

TOP: NURSING PROCESS: Planning
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

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 palatabili-
ty. 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.

11. A patient is receiving an anticonvulsant but has no history of seizures. The

nurse suspects that the patient is receiving this drug for which condition?
A. Pain associated with peripheral neuropathy
B. Inflammation pain
C. Depression associated with chronic pain
D. Prevention of possible seizures
ANS: A
Anticonvulsants are often used as adjuvants for treatment of neuropathic pain to enhance
analgesic efficacy. The other indications listed are not correct.

MULTIPLE RESPONSE
1. Vicodin (acetaminophen/hydrocodone) is prescribed for a patient who has had

surgery. The nurse informs the patient that which common adverse effects can occur with this
medication? Select all that apply.
A. Diarrhea
B. Constipation
C. Lightheadedness
D. Nervousness
E. Urinary retention
F. Itching
ANS: B, C, E, F
Constipation (not diarrhea), lightheadedness (not nervousness), urinary retention, and itching
are some of the common adverse effects that the patient may experience while taking
Vicodin.
DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: Page 160

OTHER
1. A patient is to receive codeine, 40 mg subcutaneously, every 6 hours as

needed for pain. The solution is available in a concentration of 30 mg/mL. How many
milliliters of codeine will be drawn up for this dose? Round to the nearest tenth.
ANS:
1.3 mL
30 mg : 1 mL :: 40 mg : x mL
Solve for x to equal 1.3 mL.
DIF: COGNITIVE LEVEL: Applying (Application) REF: Page N/A


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Lilley: Pharmacology and the Nursing Process, 7th Edition

Chapter 11: Analgesic Drugs

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

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

3. A patient is recovering from abdominal surgery, which he had this morning.

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

4. A 78-year-old patient is in the recovery room after having a lengthy surgery

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

5. A patient will be discharged with a 1-week supply of an opioid analgesic for

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

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

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

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

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

10. A patient is to receive acetylcysteine (Mucomyst) as part of the treatment for

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

11. A patient is receiving an anticonvulsant but has no history of seizures. The

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 158

1. Vicodin (acetaminophen/hydrocodone) is prescribed for a patient who has had

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: Page 160

1. A patient is to receive codeine, 40 mg subcutaneously, every 6 hours as

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page N/A

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