Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,QUESTION 1
Item Type: Multiple-Choice Question (MCQ)
Clinical Scenario
A 68-year-old patient with metastatic bone cancer is admitted
to the medical-surgical unit with severe pain rated 9/10. The
patient has been taking oxycodone extended-release 40 mg
every 12 hours at home but reports inadequate pain control for
the past 3 days. The healthcare provider orders hydromorphone
2 mg IV push every 4 hours PRN for breakthrough pain. The
nurse reviews the medication order before administration.
Question Stem
Which nursing action is the highest priority before
administering the first dose of IV hydromorphone?
Answer Options
A. Assess the patient's baseline respiratory rate and oxygen
saturation
B. Evaluate the patient's pain using a standardized pain
assessment tool
C. Verify the patient's allergy status and previous opioid
tolerance
D. Review the patient's current medication list for potential
drug interactions
,Correct Answer
A. Assess the patient's baseline respiratory rate and oxygen
saturation
Comprehensive Rationale
Hydromorphone is a potent semisynthetic opioid agonist with
approximately 5-7 times the analgesic potency of morphine.
The primary concern with opioid administration is respiratory
depression, which occurs through stimulation of mu-opioid
receptors in the brainstem respiratory centers. This action
reduces the responsiveness of respiratory centers to carbon
dioxide, leading to decreased respiratory rate and depth.
Before administering any opioid, especially IV opioids, the nurse
must assess the patient's baseline respiratory status to establish
a reference point for monitoring therapeutic response and
adverse effects. Respiratory rate < 12 breaths/min or oxygen
saturation < 90% are contraindications to opioid administration
without further evaluation and healthcare provider notification.
The pharmacokinetics of IV hydromorphone include rapid onset
(5-10 minutes), peak effect (15-30 minutes), and duration of 2-4
hours. This rapid onset increases the risk of acute respiratory
depression, making baseline assessment critical.
Distractor Analysis
, B. Evaluate the patient's pain using a standardized pain
assessment tool
• Why Incorrect: While pain assessment is important, it is
not the highest priority before initial IV opioid
administration. The immediate safety concern is
respiratory status.
• Common Misconception: Nurses may prioritize pain
assessment because the medication is being given for pain,
but safety assessment takes precedence.
• Safety Risk: Administering opioids without assessing
baseline respiratory status could result in unrecognized
respiratory depression.
• Appropriate Action: Pain assessment should occur as part
of the comprehensive evaluation but after ensuring
respiratory safety.
C. Verify the patient's allergy status and previous opioid
tolerance
• Why Incorrect: While medication reconciliation and allergy
verification are essential, this patient has been taking a
similar opioid (oxycodone), making true allergy less likely.
This should be completed but is not the highest priority.
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,QUESTION 1
Item Type: Multiple-Choice Question (MCQ)
Clinical Scenario
A 68-year-old patient with metastatic bone cancer is admitted
to the medical-surgical unit with severe pain rated 9/10. The
patient has been taking oxycodone extended-release 40 mg
every 12 hours at home but reports inadequate pain control for
the past 3 days. The healthcare provider orders hydromorphone
2 mg IV push every 4 hours PRN for breakthrough pain. The
nurse reviews the medication order before administration.
Question Stem
Which nursing action is the highest priority before
administering the first dose of IV hydromorphone?
Answer Options
A. Assess the patient's baseline respiratory rate and oxygen
saturation
B. Evaluate the patient's pain using a standardized pain
assessment tool
C. Verify the patient's allergy status and previous opioid
tolerance
D. Review the patient's current medication list for potential
drug interactions
,Correct Answer
A. Assess the patient's baseline respiratory rate and oxygen
saturation
Comprehensive Rationale
Hydromorphone is a potent semisynthetic opioid agonist with
approximately 5-7 times the analgesic potency of morphine.
The primary concern with opioid administration is respiratory
depression, which occurs through stimulation of mu-opioid
receptors in the brainstem respiratory centers. This action
reduces the responsiveness of respiratory centers to carbon
dioxide, leading to decreased respiratory rate and depth.
Before administering any opioid, especially IV opioids, the nurse
must assess the patient's baseline respiratory status to establish
a reference point for monitoring therapeutic response and
adverse effects. Respiratory rate < 12 breaths/min or oxygen
saturation < 90% are contraindications to opioid administration
without further evaluation and healthcare provider notification.
The pharmacokinetics of IV hydromorphone include rapid onset
(5-10 minutes), peak effect (15-30 minutes), and duration of 2-4
hours. This rapid onset increases the risk of acute respiratory
depression, making baseline assessment critical.
Distractor Analysis
, B. Evaluate the patient's pain using a standardized pain
assessment tool
• Why Incorrect: While pain assessment is important, it is
not the highest priority before initial IV opioid
administration. The immediate safety concern is
respiratory status.
• Common Misconception: Nurses may prioritize pain
assessment because the medication is being given for pain,
but safety assessment takes precedence.
• Safety Risk: Administering opioids without assessing
baseline respiratory status could result in unrecognized
respiratory depression.
• Appropriate Action: Pain assessment should occur as part
of the comprehensive evaluation but after ensuring
respiratory safety.
C. Verify the patient's allergy status and previous opioid
tolerance
• Why Incorrect: While medication reconciliation and allergy
verification are essential, this patient has been taking a
similar opioid (oxycodone), making true allergy less likely.
This should be completed but is not the highest priority.
