Week One: Acute Pain and Pharmacology

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Questions and Answers

What is the primary concern for a nurse administering naproxen to a client with chronic kidney disease?

Monitoring for gastrointestinal bleeding risks

Educating the client on the importance of hydration

Consulting with the prescriber regarding dosing adjustments (correct)

Administering naproxen on an empty stomach for better absorption

Which intervention is the most crucial for a client on amitriptyline to avoid serious complications?

Assessing for signs of serotonin syndrome

Evaluating possible interactions with other medications (correct)

Monitoring for signs of sleep disturbances

Checking for pre-existing cardiovascular disorders

What is the most important nursing consideration when administering gabapentin to a client?

Scheduling doses around meal times

Restricting dietary magnesium intake

Monitoring the client’s renal function periodically (correct)

Encouraging frequent hydration to prevent side effects

What should the nursing focus be when a client on warfarin is prescribed a new analgesic?

Confirming drug-to-drug interaction potentials Signup and view all the answers

What is the most appropriate response for a nurse when a client experiences sedation after receiving an opioid?

Monitor the client's respiratory function carefully Signup and view all the answers

When monitoring a client with chronic arthritis using celecoxib, what is essential for the nurse to communicate?

Signs of bleeding should be monitored closely and reported Signup and view all the answers

What is the most appropriate time frame for administering IV morphine to ensure patient safety?

Administer over 4 to 5 minutes Signup and view all the answers

What is the critical nursing response when a patient's respiratory rate drops below 12 breaths per minute before opioid administration?

Withhold the medication and notify the physician Signup and view all the answers

Which of the following is a significant risk associated with the use of buprenorphine for patients experiencing breakthrough pain?

It is an agonist-antagonist that can interfere with the effects of other opioids Signup and view all the answers

What is the minimum expected hourly urinary output for patients receiving opioid analgesics, given potential risks of retention?

30ml/hr Signup and view all the answers

In the context of severe pain during a vaso-occlusive crisis, what potentially harmful outcome should be monitored?

Diminished perfusion leading to further pain Signup and view all the answers

What primary mechanism does Amiodarone, a Class III antidysrhythmic medication, use to affect heart rhythm?

Prolonging the action potential and refractory period Signup and view all the answers

Which medication is indicated for patients with severe renal impairment?

Loop diuretics Signup and view all the answers

In the context of calcium's role during muscle contraction, which statement is accurate?

It activates the enzyme for actin and myosin interaction. Signup and view all the answers

What critical symptom should a patient on ACE inhibitors report that may indicate a serious side effect?

Sore throat and fever Signup and view all the answers

What describes the contraindication related to the use of diltiazem?

Hypotension Signup and view all the answers

What is the primary reason for ensuring that a client's finger is not tourniqueted before administering lidocaine?

It avoids ischemia and gangrene in areas with end arteries. Signup and view all the answers

Which of the following represents a serious concern when combining an opioid with lorazepam?

Potential for respiratory depression and sedation. Signup and view all the answers

What is the appropriate action for a nurse when managing breakthrough pain in a patient with cancer?

Consult with the physician for additional medication orders. Signup and view all the answers

What is the correct definition of complementary proteins?

Incomplete proteins that, when consumed together, provide a complete protein profile. Signup and view all the answers

In the context of nutrition, what is the primary role of essential fatty acids in the body?

They support various metabolic processes and are crucial for blood clotting. Signup and view all the answers

What is the total fiber Adequate Intake (AI) recommended for adult males?

38 g/day. Signup and view all the answers

How does the body respond to elevated blood glucose levels after carbohydrate ingestion?

Stimulates the release of insulin from the pancreas. Signup and view all the answers

What is the maximum recommended quantity of milk for toddlers to prevent displacing iron-rich foods?

24 oz. Signup and view all the answers

What is the typical age range for toddlers?

1 to 3 years old Signup and view all the answers

Which food item should be generally avoided for toddlers to reduce choking risks?

Nuts Signup and view all the answers

What common nutritional risk might preschoolers face regarding meal timing and frequency?

Higher absorption of lead on an empty stomach Signup and view all the answers

At what age does the female adolescent growth spurt typically commence?

10 years Signup and view all the answers

Which statement about adolescent dietary needs is correct?

Adolescents typically have higher iron requirements than adults. Signup and view all the answers

What is the recommended maximum intake of calcium for adolescents?

1,300 mg/day Signup and view all the answers

What eating behavior is commonly observed among school-age children?

Consuming snacks only when bored Signup and view all the answers

What heart rate can the AV node sustain if the SA node fails?

40 to 60 beats per minute Signup and view all the answers

What is the effect of sympathetic stimulation on heart rate?

Increases heart rate and conduction speed Signup and view all the answers

What is the typical heart rate range classified as sinus heart rate?

60 to 100 beats per minute Signup and view all the answers

What factor is critical in determining the need for hemodynamic monitoring?

Severity of underlying condition Signup and view all the answers

Which medication can lead to significant diuresis while having renal impairment?

Furosemide Signup and view all the answers

What is the primary consequence of inadequate left ventricle output?

Inadequate tissue perfusion Signup and view all the answers

Which classification stage indicates cardiac structural abnormalities without heart failure symptoms?

Stage B Signup and view all the answers

In hemodynamic monitoring, which parameter would be expected to rise in acute heart failure?

Pulmonary artery pressure (PAP) Signup and view all the answers

Which action is NOT recommended immediately post-exercise stress test?

Resume normal activities immediately Signup and view all the answers

What clinical symptom is least likely to be associated with left-sided heart failure?

Jugular vein distention Signup and view all the answers

What laboratory marker is considered a direct indicator of heart failure severity?

B-type natriuretic peptides (BNP) Signup and view all the answers

What is a common consequence associated with hypokalemia?

Muscle spasms Signup and view all the answers

Which dietary regimen is essential for heart failure patients?

Strict sodium reduction Signup and view all the answers

Study Notes

Acute Pain and Cancer Pain Management

Safe administration of IV morphine requires administering over 4 to 5 minutes to ensure patient safety.
Minimum hourly urinary output expected for patients on opioid analgesics is 30 ml/hr.
Buprenorphine is unsuitable for breakthrough pain due to its agonist-antagonist properties interfering with other opioids.
If a patient’s respiratory rate is below 12/min before opioid administration, withhold medication and notify the doctor.
Flumazenil is primarily administered to reverse the effects of benzodiazepines in cases of toxicity.
Assess a patient's pain level 30 minutes to 1 hour after administering hydromorphone for effective management.
In vaso-occlusive crises, severe pain can lead to diminished perfusion, increasing pain.
Long-term ibuprofen therapy requires monitoring for gastrointestinal bleeding and tinnitus.
In cases of breakthrough pain, notify the doctor for dosage adjustment as the first action.
Diazepam is prescribed during alcohol detoxification to alleviate anxiety and minimize withdrawal effects.
For patients with chronic kidney disease on naproxen, holding the medication and consulting with the prescriber is crucial.
Celecoxib may pose an increased risk of heart attack and stroke; patients should be informed accordingly.
If sedation occurs post-opioid administration, monitoring the client’s respiratory rate is the most important nursing action.
For patients on carbamazepine exhibiting tremors, notifying the provider is critical.
Naloxone is the primary medication for treating acute narcotic toxicity in newborns.
Close monitoring of INR is essential for clients taking acetaminophen while on warfarin.
Vital sign assessment is crucial for patients receiving fentanyl, focusing on respiratory rate.
Butorphanol users should be aware of opioid withdrawal symptoms.
Patients on amitriptyline and ibuprofen must be monitored for increased CNS effects.
Propranolol for migraine prophylaxis requires monitoring heart rate and blood pressure closely.
Chronic pain is categorized for clients with arthritis due to ongoing discomfort beyond tissue healing.
Referred pain occurs when internal pain is felt in an area away from the source.

Pharmacological Strategies

Neuropathic pain is best treated with adjuvant analgesics like gabapentin.
Breakthrough pain in patients requires consulting a physician for additional medication orders.
For clients with liver disease, opioid dosages should be minimal and closely monitored.
Pain level assessment is crucial for clients using transdermal fentanyl patches.
Clients taking oxycodone must monitor for respiratory depression and orthostatic hypotension.
History of seizures is a contraindication for prescribing amitriptyline.
Dexamethasone dosage must be gradually reduced over time after prolonged use.
Clients starting on gabapentin require monitoring of their basic metabolic panel.

Nutrition Basics

Carbohydrates are essential for supplying energy to the body, with a minimum daily intake of 130 g required for brain fuel.
Complex carbohydrates include starch and play a role in energy storage.
Dietary fiber aids digestion and is indigestible, affecting overall health.
Complementary proteins provide a complete protein profile when combined.
Essential fatty acids support metabolic processes and blood clotting.
Protein underconsumption can lead to conditions like Protein Energy Malnutrition (PEM).
Saturated fats are typically solid at room temperature and animal-derived.
Dietary recommendations state 38 g of total fiber for adult males and 24 oz of milk maximum for toddlers.
To boost iron absorption from plant sources, combine with vitamin C sources.
The female adolescent growth spurt typically begins at 10 years, with higher iron needs compared to adults.
School-age children may exhibit poor eating behaviors, such as snacking when bored.

Cardiac Functions and Physiology

The AV node can maintain a heart rate of 40 to 60 beats per minute if the SA node fails.
Sympathetic stimulation increases heart rate and conduction speed in the heart.
The circumflex artery supplies the left atrium and lateral surfaces of the left ventricle.
Normal sinus heart rate ranges from 60 to 100 beats per minute.
If both the SA and AV nodes fail, Purkinje fibers can act as a pacemaker at 20 to 40 beats per minute.
Baroreceptor activity causes decreased heart rate and arterial pressure in response to increased arterial pressure.
The heart's endocardium lines its inner chambers, while the myocardium is responsible for contraction.
The tricuspid valve prevents backflow into the right atrium during ventricular contraction.
The visceral pericardium protects the heart and produces lubricating pericardial fluid.

General Heart Anatomy and Functions

The left ventricle pumps oxygenated blood into systemic circulation.
The sinoatrial (SA) node initiates and regulates heartbeats.
The right atrium receives deoxygenated blood from the body.
The parietal pericardium is located outside the visceral pericardium, encasing the heart.### Cardiac Assessments
Average pericardial fluid volume in the pericardial space is 5 to 20 mL.
Recommended fasting before lipid profile sampling is 12 to 14 hours.
Troponin I is a key cardiac enzyme for diagnosing myocardial infarction.
A lipid profile primarily assesses cholesterol levels.
Transthoracic echocardiogram serves to diagnose valve disorders and evaluate cardiac structures.
Normal total cholesterol range is considered less than 200 mg/dL.

Hemodynamic Monitoring

Patients should be NPO (nothing by mouth) for 4 to 6 hours before transesophageal echocardiography.
Mild atrial fibrillation is not an indication for hemodynamic monitoring.
Pulmonary artery catheter insertion position is typically supine or in Trendelenburg position.
Mixed venous oxygen saturation (SvO2) measures the balance between oxygen supply and demand.
Post-exercise stress test, patients’ vital signs and blood pressure should be monitored closely.

Diastolic heart failure results in inadequate left ventricle output and compromised tissue perfusion.
Stage B in ACC/AHA classification indicates cardiac structural abnormalities without heart failure symptoms.
Class IV in NYHA classification signifies patients with manifestations at rest.
Severe heart failure can lead to pulmonary edema, typically associated with left-sided heart failure.
Right-sided heart failure common consequences include peripheral edema.
High-output heart failure is often linked to septicemia.

Medications and Treatments

B-type natriuretic peptides (BNP) effectively indicate heart failure severity.
Patients at risk for heart failure should follow fluid restrictions.
Furosemide is a high-ceiling loop diuretic effective even in renal impairment.
Watch for hypotension as a potential complication when using loop diuretics.
Thiazide diuretics are contraindicated in renal impairment.
Regular monitoring of electrolyte levels is critical for patients on loop diuretics.

Anesthesia Management

General anesthesia is the choice for surgeries needing complete relaxation.
Genetic predisposition to malignant hyperthermia is a risk factor for general anesthesia.
Moderate sedation allows patient awareness but can cause anxiety reduction.
Key priority while managing anesthesia is ensuring airway patency.
Severe hypotension can occur as a complication of epidural anesthesia.
Anesthesia awareness refers to situations where patients are conscious during surgery.

Muscle and Bone Health

Calcium plays a crucial role in muscle contraction by activating actin and myosin interaction.
Spongy bone is structured to withstand multidirectional forces, found at long bone ends.
Simple fractures maintain skin integrity over the site, reducing infection risk.
Bone healing stages include hematoma formation and callus formation, with remodeling following.

Diagnostic Procedures

Dual-energy x-ray absorptiometry (DEXA) assesses bone mass across key sites and total body composition.
After bone scans, ensuring hydration enhances renal filtering of the tracer.
Electromyography (EMG) can cause mild discomfort and requires patient education.

General Notes

Regular reporting of potassium levels is essential in patients taking diuretics, especially to prevent digoxin toxicity.
Benzodiazepines are used to promote amnesia and decrease anxiety in the perioperative setting.
Systemic toxicity from local anesthetics may manifest as increased heart rate and requires careful monitoring.

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Description

This quiz covers key concepts related to acute pain management, cancer pain, and the pharmacological approaches to treatment. Test your knowledge on the safe administration of IV morphine and expected urinary output for patients on opioid analgesics. Dive into important pharmacology and nutrition topics relevant to pain management.