Nursing Practice Exam #1: IV Morphine

Medication Administration and Monitoring for Opioids

• Priority nursing action for IV bolus morphine is to monitor respiration and have Narcan available.
• IV morphine should be administered over 4 to 5 minutes to minimize adverse effects.
• Peak effect time for oral morphine is 60 to 90 minutes.
• Morphine can improve hemodynamics by reducing preload.
• Minimum hourly urinary output expected for opioid analgesics is 30 ml/hr.

Pain Management Strategies

• Fentanyl is commonly prescribed for breakthrough pain in clients on scheduled morphine.
• Meperidine is not recommended for breakthrough pain due to CNS effects like seizures.
• Buprenorphine is also avoided for breakthrough pain because it may interfere with other opioids.

Pediatric and Emergency Care

• During a hypercyanotic episode in infants, the preferred position is knee-chest.
• The first action for a child with full-thickness burns is to administer IV fluids.

Medication Considerations

• Contraindication for QT prolonging medications is hypotension.
• Corticosteroids are utilized in systemic SLE for their rapid anti-inflammatory action.
• Patients receiving morphine should be taught to increase oral fluids and void regularly to prevent constipation.

Opioid Usage and Safety

• Methadone is used as a substitute in opioid use disorder to prevent cravings and withdrawal symptoms.
• Respiratory rate decline from 20 to 12/min requires priority intervention to decrease infusion rate.
• Flumazenil is the antidote for benzodiazepine toxicity.

Gastrointestinal Treatments and Toxicities

• Diphenoxylate-atropine reduces intestinal motility to treat diarrhea.
• Activated charcoal is contraindicated for corrosive ingestion as it may cause tissue burns.
• Gastric lavage is also contraindicated for corrosive ingestions due to the risk of further injury.

Monitoring and Assessments

• Assess BNP level in heart failure patients to determine progression of the condition.
• Clients in sickle cell crisis should avoid knee and hip flexion for better perfusion and pain reduction.
• Assess patients on fentanyl patches for urinary retention every 4-6 hours.

Transdermal Fentanyl Patch Considerations

• Fentanyl patches manage severe, persistent pain, not acute postoperative pain.
• Avoid heat application over fentanyl patches as it increases drug absorption, risking respiratory depression.

Maternal and Neonatal Care

• Administer IV fluid bolus to prevent maternal hypotension before epidural anesthesia.
• Nausea and vomiting can be expected side effects of epidural anesthesia.
• For magnesium sulfate-treated patients, prepare calcium gluconate for suspected toxicity leading to respiratory depression.

Opioid Reversal and Withdrawal Management

• Naloxone should be prepared for patients with opioid-induced respiratory depression.
• Diazepam is administered to minimize alcohol withdrawal symptoms, while buprenorphine is for opioid detoxification.
• Naltrexone is used for long-term maintenance following opioid detoxification.

Alcohol and Nicotine Dependence

• Disulfiram produces an aversive reaction to alcohol; patients must abstain from alcohol for 12 hours prior.
• Varenicline aids nicotine cessation by blocking pleasurable effects of nicotine.

Miscellaneous Treatments

• Acetylcysteine is the antidote for acetaminophen overdose.
• Clonidine helps alleviate symptoms of opioid withdrawal without substituting opioids.

Newborn Care and Withdrawal

• Naloxone is contraindicated in newborns experiencing opiate withdrawal, as it could cause severe withdrawal reactions.### Naloxone and Opioid Use
• Naloxone can trigger immediate withdrawal in infants exposed to opioids during pregnancy, leading to severe symptoms like seizures.
• It is contraindicated in pediatric patients due to potential complications.

Medications for Overdose and Toxicity

• Calcium gluconate is the antidote for magnesium toxicity and helps reverse respiratory depression.
• Atropine is indicated for patients at risk for bradycardia due to beta-adrenergic blockers.

Concerns with Combined Medications

• The combination of opioids and benzodiazepines (like lorazepam) increases the risk of respiratory depression and sedation.

Newborn Respiratory Depression

• Respiratory depression in newborns is frequently caused by acute narcotic toxicity from maternal opioids administered during labor.

Alcohol Withdrawal Treatment

• Chlordiazepoxide is preferred for facilitating alcohol withdrawal due to its longer half-life compared to other benzodiazepines.

Reversal Agents

• Protamine sulfate is used to reverse the effects of heparin as it binds to heparin and inactivates its anticoagulant properties.
• Digoxin immune fab is the antidote for digoxin toxicity.

Managing Salicylate Poisoning

• Administering Vitamin K is essential for children with salicylate poisoning to decrease bleeding, as salicylates disrupt vitamin K-dependent clotting factors.

WHO Analgesic Ladder

• Following the WHO analgesic ladder, if nonopioids and adjuvant medications fail to manage pain, an opioid for moderate pain is the next step.

Pain Management for Chronic Conditions

• Amitriptyline is effective for managing chronic neuropathic pain, whereas opioids are not typically the first choice.
• An effective pain management plan for chronic arthritis should include both pharmacological and non-pharmacological interventions.

Pain Assessment in Cognitively Impaired Clients

• Observing behavioral responses and physiological changes is the most reliable method for assessing pain in clients who cannot self-report.

Breakthrough Pain Management

• Breakthrough pain requires contacting the physician for additional medication orders, rather than simply administering the next scheduled dose.

Acetaminophen Administration

• Ensure acetaminophen dosage does not exceed 4 g daily to avoid overdose, and recommend taking it with food to minimize gastrointestinal upset.

Opioid Analgesics

• Continuous monitoring of respiratory rate is crucial for clients prescribed opioid analgesics due to the risk of respiratory depression.
• Nausea after opioid use should be managed with antiemetic medications.

Transdermal Fentanyl Patch Considerations

• Regularly assess the client's pain level to check that the transdermal fentanyl patch effectively manages pain; it does not require daily changes.

Monitoring Side Effects

• Clients prescribed ibuprofen should monitor for tinnitus and gastrointestinal bleeding as potential side effects.
• Opioids like oxycodone necessitate monitoring for respiratory depression and orthostatic hypotension.

Considerations for Neuropathic Pain Medications

• Amitriptyline increases the risk of seizures and is contraindicated for clients with a history of seizures, while venlafaxine requires careful assessment.

Refractory Pain Management

• For clients with advanced cancer experiencing refractory pain, an intrathecal pain pump may be surgically implanted for effective relief.

Pain Classification

• Acute pain, such as that post-surgery, is temporary and resolves with healing, while neuropathic pain from diabetic neuropathy is characterized by burning sensations.
• Somatic pain, like throbbing pain from a broken arm, originates from bones or muscles, while referred pain can manifest from visceral issues, such as pain from appendicitis radiating to the shoulder.### Medication Management & Nursing Actions
• Assess the client's suicidal ideation before administering SNRIs such as venlafaxine, as the risk of suicide may increase, particularly in young adults.
• Notify the provider immediately if the client experiences tremors while on carbamazepine, as this may indicate neurological side effects.
• Monitor the client's basic metabolic panel when prescribing gabapentin to assess electrolyte levels, affected by anticonvulsants.
• Educate clients on amitriptyline to notify providers if depression worsens, due to increased suicide risk associated with tricyclic antidepressants.
• Always taper dexamethasone gradually over time to avoid withdrawal symptoms when prescribing corticosteroids.
• Evaluate the client's muscle strength when muscle weakness is reported after starting prednisolone, as corticosteroids can contribute to this issue.
• Regularly monitor blood pressure in clients on clonidine, as hypotension is a known side effect of the medication.
• For clients receiving intrathecal lidocaine, assess motor function regularly to detect any potential motor impairment.
• Advise clients using fentanyl patches to frequently monitor for local skin reactions, including redness or itching at the patch site.
• During regional nerve blocks, be vigilant for potential complications such as respiratory depression, hypertension, and seizures.
• If hypotension occurs after a nerve block, increase IV fluid rates to compensate for peripheral vasodilation.
• When managing clients with an epidural catheter, assess bowel and bladder function, motor function, and respiratory rate for any abnormalities.
• Report a sudden headache in a client with an epidural immediately, as it may indicate serious complications like a postdural puncture headache or infection.
• Instruct clients on continuous epidural infusions to monitor catheter sites for any local skin reactions.
• Educate clients with an epidural to report any difficulty urinating, numbness in extremities, or severe headaches to their provider.

Nutritional Management

• Fat-soluble vitamins (A, D, E, K) may become deficient in clients with chronic diarrhea due to impaired absorption of fats.
• To reduce cardiovascular risks, encourage the consumption of omega-3, omega-6, and monounsaturated fatty acids as healthier alternatives to saturated fats.
• Advise patients with type 2 diabetes to focus on complex carbohydrates like starch and fiber for better blood glucose management, avoiding rapid spikes from simple sugars.
• Recognize that chicken breast is a complete protein source; it contains all essential amino acids critical for tissue repair and wound healing.
• Ensure adequate protein intake for clients experiencing muscle wasting and weakness due to malnutrition, as it is vital for preserving muscle mass.

B-Complex and Fat-Soluble Vitamins

• Chronic alcohol abuse can lead to deficiencies in thiamin, riboflavin, and niacin, impacting energy metabolism and neurologic function.
• Vitamin B12 interacts with folate and is essential for its activation; deficiencies can cause serious health issues.
• Patients with cystic fibrosis are at risk for deficiencies in all fat-soluble vitamins (A, D, E, K) due to malabsorption.
• Symptoms such as headaches and blurred vision may indicate vitamin A toxicity, necessitating discontinuation of supplements and medical consultation.
• Vitamin B12 (cobalamin) deficiency is a major concern for vegans due to its natural occurrence only in animal products; supplementation or fortified foods are necessary.

Vitamin D, E, K, and Major Minerals

• Clients with osteoporosis require adequate calcium intake to maintain bone density and prevent fractures.
• Calcium is crucial not just for bone health but overall metabolic functions.

Medication Administration and Monitoring for Opioids

• Priority nursing action for IV bolus morphine is to monitor respiration and have Narcan available.
• IV morphine should be administered over 4 to 5 minutes to minimize adverse effects.
• Peak effect time for oral morphine is 60 to 90 minutes.
• Morphine can improve hemodynamics by reducing preload.
• Minimum hourly urinary output expected for opioid analgesics is 30 ml/hr.

Pain Management Strategies

• Fentanyl is commonly prescribed for breakthrough pain in clients on scheduled morphine.
• Meperidine is not recommended for breakthrough pain due to CNS effects like seizures.
• Buprenorphine is also avoided for breakthrough pain because it may interfere with other opioids.

Pediatric and Emergency Care

• During a hypercyanotic episode in infants, the preferred position is knee-chest.
• The first action for a child with full-thickness burns is to administer IV fluids.

Medication Considerations

• Contraindication for QT prolonging medications is hypotension.
• Corticosteroids are utilized in systemic SLE for their rapid anti-inflammatory action.
• Patients receiving morphine should be taught to increase oral fluids and void regularly to prevent constipation.

Opioid Usage and Safety

• Methadone is used as a substitute in opioid use disorder to prevent cravings and withdrawal symptoms.
• Respiratory rate decline from 20 to 12/min requires priority intervention to decrease infusion rate.
• Flumazenil is the antidote for benzodiazepine toxicity.

Gastrointestinal Treatments and Toxicities

• Diphenoxylate-atropine reduces intestinal motility to treat diarrhea.
• Activated charcoal is contraindicated for corrosive ingestion as it may cause tissue burns.
• Gastric lavage is also contraindicated for corrosive ingestions due to the risk of further injury.

Monitoring and Assessments

• Assess BNP level in heart failure patients to determine progression of the condition.
• Clients in sickle cell crisis should avoid knee and hip flexion for better perfusion and pain reduction.
• Assess patients on fentanyl patches for urinary retention every 4-6 hours.

Transdermal Fentanyl Patch Considerations

• Fentanyl patches manage severe, persistent pain, not acute postoperative pain.
• Avoid heat application over fentanyl patches as it increases drug absorption, risking respiratory depression.

Maternal and Neonatal Care

• Administer IV fluid bolus to prevent maternal hypotension before epidural anesthesia.
• Nausea and vomiting can be expected side effects of epidural anesthesia.
• For magnesium sulfate-treated patients, prepare calcium gluconate for suspected toxicity leading to respiratory depression.

Opioid Reversal and Withdrawal Management

• Naloxone should be prepared for patients with opioid-induced respiratory depression.
• Diazepam is administered to minimize alcohol withdrawal symptoms, while buprenorphine is for opioid detoxification.
• Naltrexone is used for long-term maintenance following opioid detoxification.

Alcohol and Nicotine Dependence

• Disulfiram produces an aversive reaction to alcohol; patients must abstain from alcohol for 12 hours prior.
• Varenicline aids nicotine cessation by blocking pleasurable effects of nicotine.

Miscellaneous Treatments

• Acetylcysteine is the antidote for acetaminophen overdose.
• Clonidine helps alleviate symptoms of opioid withdrawal without substituting opioids.

Newborn Care and Withdrawal

• Naloxone is contraindicated in newborns experiencing opiate withdrawal, as it could cause severe withdrawal reactions.### Naloxone and Opioid Use
• Naloxone can trigger immediate withdrawal in infants exposed to opioids during pregnancy, leading to severe symptoms like seizures.
• It is contraindicated in pediatric patients due to potential complications.

Medications for Overdose and Toxicity

• Calcium gluconate is the antidote for magnesium toxicity and helps reverse respiratory depression.
• Atropine is indicated for patients at risk for bradycardia due to beta-adrenergic blockers.

Concerns with Combined Medications

• The combination of opioids and benzodiazepines (like lorazepam) increases the risk of respiratory depression and sedation.

Newborn Respiratory Depression

• Respiratory depression in newborns is frequently caused by acute narcotic toxicity from maternal opioids administered during labor.

Alcohol Withdrawal Treatment

• Chlordiazepoxide is preferred for facilitating alcohol withdrawal due to its longer half-life compared to other benzodiazepines.

Reversal Agents

• Protamine sulfate is used to reverse the effects of heparin as it binds to heparin and inactivates its anticoagulant properties.
• Digoxin immune fab is the antidote for digoxin toxicity.

Managing Salicylate Poisoning

• Administering Vitamin K is essential for children with salicylate poisoning to decrease bleeding, as salicylates disrupt vitamin K-dependent clotting factors.

WHO Analgesic Ladder

• Following the WHO analgesic ladder, if nonopioids and adjuvant medications fail to manage pain, an opioid for moderate pain is the next step.

Pain Management for Chronic Conditions

• Amitriptyline is effective for managing chronic neuropathic pain, whereas opioids are not typically the first choice.
• An effective pain management plan for chronic arthritis should include both pharmacological and non-pharmacological interventions.

Pain Assessment in Cognitively Impaired Clients

• Observing behavioral responses and physiological changes is the most reliable method for assessing pain in clients who cannot self-report.

Breakthrough Pain Management

• Breakthrough pain requires contacting the physician for additional medication orders, rather than simply administering the next scheduled dose.

Acetaminophen Administration

• Ensure acetaminophen dosage does not exceed 4 g daily to avoid overdose, and recommend taking it with food to minimize gastrointestinal upset.

Opioid Analgesics

• Continuous monitoring of respiratory rate is crucial for clients prescribed opioid analgesics due to the risk of respiratory depression.
• Nausea after opioid use should be managed with antiemetic medications.

Transdermal Fentanyl Patch Considerations

• Regularly assess the client's pain level to check that the transdermal fentanyl patch effectively manages pain; it does not require daily changes.

Monitoring Side Effects

• Clients prescribed ibuprofen should monitor for tinnitus and gastrointestinal bleeding as potential side effects.
• Opioids like oxycodone necessitate monitoring for respiratory depression and orthostatic hypotension.

Considerations for Neuropathic Pain Medications

• Amitriptyline increases the risk of seizures and is contraindicated for clients with a history of seizures, while venlafaxine requires careful assessment.

Refractory Pain Management

• For clients with advanced cancer experiencing refractory pain, an intrathecal pain pump may be surgically implanted for effective relief.

Pain Classification

• Acute pain, such as that post-surgery, is temporary and resolves with healing, while neuropathic pain from diabetic neuropathy is characterized by burning sensations.
• Somatic pain, like throbbing pain from a broken arm, originates from bones or muscles, while referred pain can manifest from visceral issues, such as pain from appendicitis radiating to the shoulder.### Medication Management & Nursing Actions
• Assess the client's suicidal ideation before administering SNRIs such as venlafaxine, as the risk of suicide may increase, particularly in young adults.
• Notify the provider immediately if the client experiences tremors while on carbamazepine, as this may indicate neurological side effects.
• Monitor the client's basic metabolic panel when prescribing gabapentin to assess electrolyte levels, affected by anticonvulsants.
• Educate clients on amitriptyline to notify providers if depression worsens, due to increased suicide risk associated with tricyclic antidepressants.
• Always taper dexamethasone gradually over time to avoid withdrawal symptoms when prescribing corticosteroids.
• Evaluate the client's muscle strength when muscle weakness is reported after starting prednisolone, as corticosteroids can contribute to this issue.
• Regularly monitor blood pressure in clients on clonidine, as hypotension is a known side effect of the medication.
• For clients receiving intrathecal lidocaine, assess motor function regularly to detect any potential motor impairment.
• Advise clients using fentanyl patches to frequently monitor for local skin reactions, including redness or itching at the patch site.
• During regional nerve blocks, be vigilant for potential complications such as respiratory depression, hypertension, and seizures.
• If hypotension occurs after a nerve block, increase IV fluid rates to compensate for peripheral vasodilation.
• When managing clients with an epidural catheter, assess bowel and bladder function, motor function, and respiratory rate for any abnormalities.
• Report a sudden headache in a client with an epidural immediately, as it may indicate serious complications like a postdural puncture headache or infection.
• Instruct clients on continuous epidural infusions to monitor catheter sites for any local skin reactions.
• Educate clients with an epidural to report any difficulty urinating, numbness in extremities, or severe headaches to their provider.

Nutritional Management

• Fat-soluble vitamins (A, D, E, K) may become deficient in clients with chronic diarrhea due to impaired absorption of fats.
• To reduce cardiovascular risks, encourage the consumption of omega-3, omega-6, and monounsaturated fatty acids as healthier alternatives to saturated fats.
• Advise patients with type 2 diabetes to focus on complex carbohydrates like starch and fiber for better blood glucose management, avoiding rapid spikes from simple sugars.
• Recognize that chicken breast is a complete protein source; it contains all essential amino acids critical for tissue repair and wound healing.
• Ensure adequate protein intake for clients experiencing muscle wasting and weakness due to malnutrition, as it is vital for preserving muscle mass.

B-Complex and Fat-Soluble Vitamins

• Chronic alcohol abuse can lead to deficiencies in thiamin, riboflavin, and niacin, impacting energy metabolism and neurologic function.
• Vitamin B12 interacts with folate and is essential for its activation; deficiencies can cause serious health issues.
• Patients with cystic fibrosis are at risk for deficiencies in all fat-soluble vitamins (A, D, E, K) due to malabsorption.
• Symptoms such as headaches and blurred vision may indicate vitamin A toxicity, necessitating discontinuation of supplements and medical consultation.
• Vitamin B12 (cobalamin) deficiency is a major concern for vegans due to its natural occurrence only in animal products; supplementation or fortified foods are necessary.

Vitamin D, E, K, and Major Minerals

• Clients with osteoporosis require adequate calcium intake to maintain bone density and prevent fractures.
• Calcium is crucial not just for bone health but overall metabolic functions.

Pain Management and Pharmacology

• IV Morphine Administration: Administer over 4 to 5 minutes to minimize adverse effects.
• Urinary Output Monitoring: Expected minimum hourly urinary output for opioid management is 30ml/hr.
• Buprenorphine Use: Not recommended for breakthrough pain as it can interfere with other opioids due to its agonist-antagonist properties.
• Breakthrough Pain Management: Fentanyl is the most appropriate medication for breakthrough pain in cancer patients on scheduled morphine.
• Morphine and Hemodynamics: It improves hemodynamics by reducing preload, decreasing cardiac workload.
• Respiratory Rate Monitoring: Withhold opioids if respiratory rate is below 12/min and notify the physician.
• Assessing Pain after Hydromorphone: Optimal time for pain assessment is 30 minutes to 1 hour after administration.
• Fentanyl Patch Care: Avoid heat over transdermal patches as it increases medication absorption.
• Urinary Retention Monitoring: Assessment for urinary retention in patients using fentanyl patches should be done every 4-6 hours.
• Magnesium Sulfate Toxicity: Signs in postpartum patients include somnolence and slow respiratory rate, indicating magnesium toxicity.
• Burn Care Priorities: For full-thickness burns, administer IV fluids as the first action.
• Sickle Cell Crisis: Flexing knees and hips may lead to reduced perfusion, increasing pain.
• Continuous Morphine Monitoring: A decreasing respiratory rate to below 12/min is a concern when using continuous morphine.
• Flumazenil Use: It reverses the effects of benzodiazepines during toxicity.
• Activated Charcoal Risks: Should not be used in corrosive substance ingestions as it can worsen tissue damage.
• Naloxone Use: It is the primary medication to reverse opioid-induced respiratory depression.
• Alcohol Detoxification: Diazepam is prescribed to minimize withdrawal symptoms.
• Disulfiram Mechanism: Causes unpleasant side effects when alcohol is consumed, aiding in alcohol use disorder treatment.
• Newborn Withdrawal Concerns: Naloxone may induce severe withdrawal symptoms in newborns.
• Smoking Cessation: Rimonabant blocks pleasurable nicotine effects.
• Neuropathic Pain Management: Gabapentin is effective for cancer-related neuropathic pain.
• Somatic Pain Management: External beam radiation therapy is appropriate for metastatic bone cancer pain.
• Breakthrough Pain Management: Report to healthcare provider when breakthrough pain occurs despite treatment.
• Acetaminophen in Liver Disease: Dosage may need adjustment due to potential adverse effects on liver function.
• Nausea after Opioids: Administer antiemetics for nausea following opioid use.
• Pain Management Regimens: Rotating antiepileptic medications requires frequent pain assessments.
• Cognitive Impairment and Pain: Monitor non-verbal signs for pain assessment in clients who cannot self-report.
• Long-term Ibuprofen Use: Monitor for signs of gastrointestinal bleeding and tinnitus.
• Chronic Pain Protocol: Schedule medication to maximize pain relief rather than waiting for client requests.
• Patient-Controlled Analgesia (PCA): Clients must be trained to use PCA systems independently.
• Carbamazepine Monitoring: Notify provider for tremors observed during treatment.
• Opioid Sedation: Monitor respiratory rate before taking action if sedation occurs after opioid use.
• Opioid and Lorazepam Risks: Combination may lead to respiratory depression and sedation.
• Newborn Opioid Toxicity: Naloxone is indicated for treating acute opioid toxicity in newborns.
• Calcium Gluconate Use: Administered for magnesium toxicity from magnesium sulfate.
• Naloxone Overdose Effects: Excess naloxone may cause increased pain despite improved respiratory function.
• Alcohol Withdrawal Management: Chlordiazepoxide is effective based on pharmacokinetic properties.
• Extended-release Oxycodone: Must be swallowed whole to prevent rapid medication release.
• Falls Prevention for Older Adults: Suggest clients with osteoarthritis use a cane on the non-painful side for safety.
• Postoperative Respiratory Care: Coughing and deep breathing exercises are crucial to prevent complications.
• Rheumatoid Arthritis Treatment: Initiate DMARDs within 3 months of diagnosis to prevent joint degeneration.
• Pain Reporting in Older Adults: Clients may hesitate to report pain to avoid bothering caregivers.
• Naproxen Caution: Hold administration for clients with peptic ulcer disease and consult the prescriber.
• Celecoxib Education: Emphasize the increased risk of heart attack and stroke associated with this medication.
• Warfarin Interaction: Monitoring INR is crucial when acetaminophen is prescribed alongside warfarin.
• Fentanyl Monitoring: Closely observe respiratory rates in clients with chronic kidney disease prescribed fentanyl.
• Butorphanol Activation: Teach clients to report symptoms of anxiety or restlessness, potential side effects of the medication.
• Naloxone and Opioid Withdrawal: Monitor for signs of withdrawal when naloxone is prescribed to opioid-dependent clients.
• Gabapentin and Grapefruit Juice: Advise patients to avoid grapefruit juice, which can increase gabapentin levels.
• Dexamethasone and Infection Risks: Instruct clients to avoid sick individuals, due to immunosuppressive effects.
• Amitriptyline and Ibuprofen Monitoring: Monitor for central nervous system adverse effects when these medications are taken together.
• Propranolol Monitoring: Check heart rate and blood pressure regularly in clients receiving propranolol for migraines.
• Sumatriptan Administration: Instruct clients to take this medication at the first sign of a migraine headache.### Migraine Treatment with Sumatriptan
• Sumatriptan is most effective for migraine relief when taken at the first sign of a headache.
• Early administration prevents the progression to severe pain.
• Patients should be educated on the optimal timing for taking the medication to maximize effectiveness.

Lidocaine with Epinephrine Administration

• Lidocaine with epinephrine is used for minor surgical procedures.
• The priority action for the nurse is to ensure the client's finger is not tourniqueted before administration.
• Epinephrine acts as a vasoconstrictor and is contraindicated in areas with end arteries like fingers, as it can lead to ischemia and potential gangrene.
• If a tourniquet is in place, consultation with the prescriber regarding the use of plain lidocaine is necessary to avoid complications.